THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

LOS  ANGELES 


CHEMICAL  AND  MICROSCOPICAL 


ANALYSIS  OF  THE  URINE 


HEALTH    AND    DISEASE 


DESIGNED  FOR   PHYSICIANS  AND  STUDENTS 


BY 

GEO.    B.   FOWLER,    M.D. 

EXAMINER    IN    PHT8IOLOGY,    COLLEGE    OP    PHYSICIANS     AND    SURGEONS,    NEW 

YORK,    VISITING   SURGEON  TO  THE   NEW  YORK   DISPENSARY,    FELLOW 

OK  TUB  NEW  YORK  ACADEMY  OP  MEDICINE,   MEMBER  OP  THE 

NEW  YORK  COUNTY  MEDICAL  SOCIETY,   ETC. 

Second     Edition 
REVISED  AND  ENLARGED,   WITH  EIGHTEEN  ILLUSTRATIONS 


NEW    YORK 

G.    P.     PUTNAM'S     SONS 

182   FIFTH  AVENUE 

1876. 

Jmtmf  Kenneth  Mackenzie 

879  Comteh  Drive 

San  Diego,  California  92107 

U.SA,  Planet  Earth 


COPYRIGHT. 

G.    P.    PUTNAM'S    SONS. 
1876. 


PREFACE. 


IN  this,  as  in  the  first  edition,  the  object  has  been 
to  present  the  most  practical  and  important  features 
of  the  subject.  The  book  has  been  carefully  revised, 
and  somewhat  enlarged  by  the  introduction  of  new 
matter,  but  the  same  general  arrangement  is  preserved. 

The  decimal  system  of  weights  and  measures  has 
been  adopted,  also  the  new  chemical  nomenclature 
and  notation.  To  meet  the  requirements  of  those  not 
familiar  with  the  decimal  system,  equivalents  in 
grains  or  ounces  are  usually  given  in  brackets,  and  a 
table  of  comparative  values  is  inserted  on  the  last 
page* 

OCTOBER,  1876. 


PART  I. 

1.  CHARACTERS  OF  NORMAL  URINE. 

2.  EFFECTS  OF  REAGENTS  UPON  NORMAL  URINE. 

PART  II. 

CHARACTERS  OF  ABNORMAL  URINE. 

PART  III. 
URINARY  DEPOSITS. 

1.  THOSE  WHICH  ARE  NATURAL  CONSTITUENTS  OF 
THE  URINE,  EITHER  SEPARATELY  OR  IN  COMBINATION. 

2.  THOSE  WHICH  ARE  FOREIGN  TO  ITS  COMPOSITION 
UNDER  ANY  FORM. 

PART  IY. 

ACCIDENTAL  INGREDIENTS  WHICH   DO  NOT  FORM 
DEPOSITS. 

PART  Y. 

QUANTITATIVE  ANALYSIS. 

PART  VI. 
CALCULI  AND  GRAVEL. 


ANALYSIS  OF  THE  URINE. 


PART  I. 

CHARACTERS  OF  NORMAL  URINE. 

THE  Composition   of  the   urine   per  thousand 
parts  is  as  follows  : 


Water     .......  950.00 

Urea 26.20 

Creatinine       ......  0.87 

Sodium  and  potassium  urates       .         .  1.45 

Sodium  and  potassium  hippurates    .         .  0.70 

Mucus  and  coloring  matter           .         .  0.35 

f  Sodium  biphosphate         ....  0.40 

I  Sodium  and  potassium  phosphates        .  3.35 

-|  Lime  and  magnesium  phosphates     .         .  0.83 

I  Sodium  and  potassium  chlorides           .  12.55 

I  Sodium  and  potassium  sulphates      .         .  3.30 

1000.00 


These  proportions  are  not  invariable,  but  as  in  all 
animal  fluids,  greatly  depend  upon  diet,  age,  sex, 
occupation,  etc. 

A  glance  at  the  above  table  is  sufficient  to  reveal 


6  ANALYSIS    OF    THE    URINE. 

the  fact  that  the  urine  is  practically  a  watery  solution 
of  urea  and  inorganic  salts,  the  chlorides  being  espe- 
cially abundant. 

UKEA— CH4N2O. 

This  is  the  most  important,  and  next  to  water,  the 
most  abundant  ingredient  of  the  urine.  It  is  present 
in  the  urine  of  all  animals  in  large  proportion,  except 
that  of  birds  and  scaly  amphibians,  where  it  is  almost 
wholly  replaced  by  the  urates. 

PHYSICAL  AND   CHEMICAL   CHARACTERS. 

TJrea  is  a  crystallizable  substance,  and  has  the 
chemical  composition  given  above.  The  crystals  are 
white,  delicate  needle-shaped  prisms,  very  soluble  in 
water  and  alcohol,  but  sparingly  so  in  ether.  It  is 
neutral  to  test-paper,  has  a  cooling  taste  like  saltpetre, 
and  is  without  odor.  It  never  appears  as  a  sponta- 
neous deposit  in  urine.  If  kept  protected  from  the 
atmosphere,  or  in  a  pure  watery  solution,  urea  does 
not  decompose ;  if,  however,  it  is  boiled  for  a  long 
time  in  pure  water  or  a  few  moments  with  an  alkali, 
or  heated  with  water  in  a  sealed  tube  above  100°  C., 
a  change  is  effected  whereby  ammonium  carbonate  is 
produced  by  the  appropriation  of  the  elements  of  two 
molecules  of  water,  thus  : 

Urea.  Water.  Ammonium  Carbonate. 

CH^NaO  +  H402     =     (NH4)2C03. 

The  same  phenomenon  occurs  when  a  watery  solu- 
tion of  urea  is  brought  in  contact  with  decomposing 
organic  matter.  Hence  the  ammoniacal  odor  of 
stale  urine. 


ANALYSIS     OF     THE     URINE.  7 

A  peculiar  interest  is  attached  to  urea  as  being  the 
first  organic  product  which  was  artificially  produced. 
It  was  obtained  by  Wohler  by  mixing  the  vapors  of 
cyanic  acid  and  ammonia  : 

Cyanic  Acid.  Ammonia.  Urea. 

CHNO     +     NH3    =     CH4N2O. 

The  first  result  of  this  process  is  the  formation  of 
a  neutral  cyanate ;  but  on  heating  this  is  converted 
into  urea.  To-day  urea  is  artificially  obtained  by 
several  methods  from  cyanogen  compounds,  and  by 
the  action  of  oxydizing  agents  upon  albuminous  mat- 
ters and  upon  uric  acid.  A  method  which  yields  it  in 
great  abundance  is  the  following :  Equal  quantities, 
by  weight,  of  potassium  cyanate  and  ammonium  sul- 
phate are  dissolved  in  a  little  water,  and  then  evap- 
orated to  dryness  over  the  water-bath.  The  residue 
is  boiled  with  strong  alcohol,  which  dissolves  out  the 
urea  from  the  potassium  sulphate  and  ammonium  sul- 
phate. The  alcoholic  solution  is  now  filtered,  con- 
centrated, and  allowed  to  cool,  when  the  urea  will 
show  itself  as  a  crystalline  deposit. 

To  obtain  urea  from  urine  involves  a  much  less 
satisfactory  process,  in  that  it  requires  more  manipula- 
tion, and  necessitates  the  employment  of  an  immense 
quantity  of  urine  to  commence  with,  in  order  to 
secure  an  appreciable  amount  of  the  substance  sought. 
The  process  is  as  follows  :  Urine  is  evaporated  to  a 
syrupy  consistency,  the  deposit  of  phosphates  and 
urates  being  filtered  away  as  they  appear,  and  about 
one-quarter  of  its  volume  of  strong  nitric  acid  added. 
A  crystalline  deposit  of  urea  nitrate  is  immediately 


8  ANALYSIS    OF    THE    UEINE. 

formed,  which  is  made  still  more  abundant  by  cool- 
ing. The  whole  is  then  to  be  thrown  upon  a  filter 
and  the  crystals  dried  between  folds  of  bibulous 
paper.  They  are  then  dissolved  in  a  little  warm  water 
and  the  solution  heated  with  an  excess  of  barium 
carbonate. 

The  nitric  acid  quits  the  urea,  setting  it  free,  and 
unites  with  the  barium  to  form  barium  nitrate ;  the 
liberated  carbonic  acid  manifesting  its  escape  by  effer- 
vescence. A  little  concentration  will  cause  the  barium 
nitrate  to  crystallize,  when  we  get  rid  of  it  by  filtering. 
Now  evaporate  our  watery  solution  of  urea  to  dryness 
over  the  bath  and  extract  with  as  small  amount  of  alco- 
hol as  will  dissolve  the  residue.  On  cooling  the  urea 
will  crystallize  out. 

Urea  behaves  in  some  respects  like  an  organic  base. 
It  unites  readily  with  nitric  and  oxalic  acids  to  form 
the  nitrate  and  oxalate  respectively.  Both  of  these 
products  may  be  obtained  from  the  urine,  it  being 
only  necessary  to  evaporate  this  fluid  down  to  about 
one-fourth  its  volume,  allow  it  to  cool  and  add  an  excess 
of  the  acid.  In  the  case  of  nitric  acid  there  will  be  a 
very  abundant  precipitate  of  urea  nitrate  in  the  form 
of  flat  six-sided  scales  more  or  less  colored  by  the  urine 
pigment,  and  overlying  each  other  to  such  an  extent 
as  to  almost  conceal  their  true  form. 

Urea  has  a  much  greater  affinity  for  oxalic  than  for 
nitric  acid,  and  if  we  add  a  strong  solution  of  the  for- 
mer to  the  deposit  already  obtained  the  nitrate  will  be 
decomposed,  and  a  copious  fawn-colored  mass  of  urea- 
oxalate  crystals  appear.  The  crystals  of  this  latter  for- 
mation are  very  similar  to  those  of  the  nitrate,  being 


ANALYSIS    OF    THE    URINE. 

rhombic  plates  and  prisms.  The}'  may  however  be 
distinguished  by  their  somewhat  smaller  size  and  the 
appearance  among  them  of  a  few  rather  thick  four- 
sided  prisms. 

PHYSIOLOGICAL    AND    PATHOLOGICAL    RELATIONS. 

TJrea  is  the  product  of  the  retrograde  metamorpho- 
sis of  the  nitrogenous  constituents  of  the  body.  It  is 
not  formed  in  the  kidneys,  as  once  supposed,  but  ex- 
ists in  the  blood  of  the  general  circulation  in  the  pro- 
portion of  about  0.16  parts  per  thousand.  It  has  also 
been  discovered  in  the  lymph  and  chyle,  the  humors 
of  the  eye,  and  in  the  perspiration. 

Whether  urea  is  produced  in  the  solid  tissues  or  in 
the  blood  is  not  determined,  but  it  is  quite  evident 
that  the  kidneys  simply  serve  as  eliminators  of  it ; 
because  it  is  found  that  the  renal  veins  contain  much 
less  urea  than  do  the  renal  arteries ;  and  if  the  latter 
vessels  be  tied  there  is  a  very  marked  increase  of  urea 
in  the  blood. 

Urea  is  excreted  at  the  rate  of  about  35  grammes 
(525  grains)  per  day.  But  this  process  depends  very 
greatly  upon  several  conditions  which  are  never  to 
be  overlooked.  The  most,  important  are  age,  sex, 
bodily  weight,  food  and  muscular  activity. 

Women  and  children  produce  less  urea  than  men, 
though  in  children  there  is  more  in  proportion  to 
the  weight.  (Harley.  Scherer.  Becquerel.)  Large 
people  excrete  more  urea  than  small  ones.  The  pro- 
portion is  about  .5  per  thousand  parts  of  the  weight. 
All  observers  agree  that  the  excretion  of  urea  is  aug- 
mented under  the  influence  of  a  nitrogenous  diet,  and 


10  ANALYSIS    OF    THE    URINE. 

diminished  to  a  minimum  by  the  use  of  food  strictly 
non-nitrogenous. 

Five-sixths  of  all  the  nitrogen  ingested  has  been 
found  in  the  urinary  solids ;  and  the  entire  quantity 
is  to  be  detected  in  the  urine  and  feces.1  Practically 
urea  represents  all  the  nitrogen  excreted. 

Whether  muscular  exercise  affects  the  amount  of 
urea  discharged  has  been  long  a  mooted  question  and 
the  subject  of  numerous  careful  and  laborious  experi- 
ments. Liebig  promulgated  the  doctrine  that  the 
tissues  consume  their  own  substance  with  the  result 
to  eliminate  an  amount  of  nitrogen  proportionate  to 
their  activity.  This  view,  however,  has  lately  been 
assailed  and  in  turn  supported  by  many  eminent 
observers. 

According  to  Parkes  there  is  no  increase  of  nitro- 
gen— i.  e.,  urea — during  unusual  muscular  exercise, 
but  after  such  a  period  the  increase  is  very  striking.1 

Tick  and  Wislicinus,8  two  German  experimenters, 
estimated  the  amount  of  urea  discharged  by  themselves 
before,  during  and  after  the  ascent  of  a  high  mountain 
on  foot,  the  diet  consisting  of  n  on -nitrogenous  food. 
The  results  obtained  showed  that  there  was  less  urea 
eliminated  for  a  given  time  during  the  work  than  be- 
fore. At  night,  having  arrived  at  the  top,  they  par- 
took of  a  mixed  meal  which  had  the  effect  to  augment 

1  Parkes.       Proceedings    of    the    Royal    Society,    June    20, 
1867,  and   Lehmann,  Physiological   Chemistry.     Am.  ed.,  vol.  1, 
p.  151. 

2  Proceedings  of  the  Royal  Society,  Jan.,  1867.     Vol.  xv.  Id. 
vol.  xvi.  Id.  March,  1871. 

3  "  On  the  origin  of  muscular   Power,"  Philosophical  Mag. 
(Supplement)  vol.  xxxi.,  1866. 


ANALYSIS    OF    THE    URINE.  11 

the  nitrogenous  discharge,  but  it  did  not  with  either 
individual  equal  that  excreted  before  the  work.  The 
most  extensive  and  conclusive  experiments  on  this  sub- 
iect,  however,  are  those  performed  upon  the  pedestrian 
Weston,  by  Prof.  A.  Flint,  Jr.1  In  these  observations 
the  greatest  care  was  taken  in  all  the  details.  The 
amount  of  nitrogen  in  the  food  was  calculated  as  well 
as  that  excreted,  in  order  to  avoid  any  error  which 
might  arise  from  the  variation  in  the  diet.  Weston 
was  under  observation  fifteen  days — five  days  before, 
five  days  during  and  five  days  after  the  walk.  The 
result  was  that  the  increase  of  urea  discharged  during 
the  period  of  exertion  was  very  marked. 

These  results  have  very  recently  received  additional 
support  by  experiments  upon  the  same  individual,  du- 
ring a  recent  trial  of  endurance  in  London,  conducted 
by  Dr.  Pavy, 2  who  had  never  accepted  Prof.  Flint's 
conclusions,  but  who.  on  the  contrary,  held  quite  op- 
posite views.  It  then  appears  settled  that  nitrogen- 
ous food  and  muscular  activity  increase  the  discharge 
of  urea.  But  whether  in  the  case  of  food  the  result 
is  due  to  an  excess  of  nitrogenous  material  in  the 
blood  being  directly  transformed  into  the  excretion  or 
whether  the  tissues  are  stimulated  to  more  active 
metamorphosis  by  this-  excess,  is  a  question  as  yet  un- 
decided. 

The  excretion  of  urea  varies  with  the  different 
periods  of  the  day,  being  less  in  the  morning  and 
greatest  at  night.  Indeed  we  have  seen  specimens  of 
urine  passed  late  in  the  afternoon  and  evening  which 

1  New  York  Medical  Journal,  June,  1871,  p.  669. 
8  London  Lancet,  1876.    Vol.  I.,  No.  ix.  et  seq. 


12  t  ANALYSIS    OF    THE     UKINE. 

gave  an  abundant  precipitate  with  nitric  acid  (urea 
nitrate)  without  previous  manipulation. 

As  a  general  rule  an  excessive  discharge  of  water 
by  the  kidneys  is  accompanied  by  an  augmentation  in 
the  amount  of  urea,  and  a  diminished  flow  by  a  de- 
crease. 

Urea  is  formed  and  excreted  as  long  as  the  vital 
functions  are  performed,  whatever  be  the  diet,  and 
even  when  all  food  is  withheld. 

In  disease  the  production  of  urea  may  be  both  in- 
creased and  diminished.  It  is  increased  in  most  febrile 
and  inflammatory  diseases  such  as  pneumonia,  perito- 
nitis, etc.,  but  during  convalescence  sinks  below  the 
normal  average.  In  diabetes  mellitus,  where  the 
patient  takes  enormous  quantities  of  food,  the  total 
daily  quantity  of  urea  may  be  60  or  TO  grammes,  (900 
or  1050  grs).  In  diabetes  insipidus  it  is  also  increased, 
evidently  on  account  of  the  excessive  amount  of  water 
ingested. 

The  excretion  of  urea  is  diminished  in  renal  dis- 
eases, cholera,  phthisis  and  all  other  chronic  affections 
accompanied  by  impaired  nutrition.  It  is,  however, 
evident  that  these  deviations  are  not  all  due  to  the 
same  cause.  In  diseases  which  interfere  with  the  func- 
tions of  the  kidneys,  the  same  amount  of  urea  may  be 
formed  as  in  health,  but  the  kidneys  being  impaired  it 
accumulates  in  the  circulation  ;  while  in  diseases  char- 
acterized by  a  chronic  torpidity  of  the  vital  forces  the 
metamorphosis  of  the  tissues  and  food  is  retarded — but 
the  small  amount  produced  is  properly  drained  away 
from  the  blood  by  the  kidneys. 

In  Bright's  disease  the  failure  of  the  urea  to  be 


ANALYSIS    OF    THE    URINE.  13 

separated  from  the  blood  causes  it  to  collect  there  in 
great  quantity,  and  also  to  appear  in  every  tissue  and 
fluid  of  the  body.  Thus  confined  it  acts  as  a  poison 
upon  the  nervous  system  inducing  what  is  known  as 
uraemia.  Retained  any  length  of  time  in  the  urinary 
organs  urea  is  decomposed  into  ammonium  carbonate, 
which  is  absorbed  and  gives  rise  to  a  diseased  condition 
called  ammonmmia.  Whether  urea  is  thus  changed  in 
the  blood  and  uraemia  and  ammonaemia  are  identical  is 
not  known.  The  method  of  estimating  the  quantity 
of  urea  will  be  given  in  another  place. 


This  is  another  excretory  product  closely  resem- 
bling urea  in  that  it  is  crystallizable,  contains  nitrogen 
and  has  the  properties  of  an  organic  base.  Yery 
little  is  known  concerning  it  further  than  that  it 
exists  in  small  amount  in  muscle,  and  that  it  can  be 
obtained  from  creatine  of  muscle,  by  the  separation 
of  the  elements  of  water,  as  follows  : 

Creatine.  Water.  Creatinine. 

—  H20  -  C4H7N30. 


Both  creatine  and  creatinine  exist  in  the  urine  to  a 
very  small  extent.  They  are  probably  intermediate 
formations  in  the  metamorphosis  of  nitrogenous  mat- 
ters towards  urea,  uric  acid,  carbonic  acid  and  water. 

The  remaining  ingredients  of  the  urine  which  have 
a  practical  interest  will  be  considered  under  "  urinary 
deposits." 

Color.  —  The  tint  of  healthy  urine  is  liable  to  va- 


14  ANALYSIS    OF    THE    UKINE. 

riation,  though  a  yellow  amber  is  about  the  standard 
color. 

The  coloring  matter  of  urine  is  a  peculiar  organic 
constituent  which  though  diligently  studied  is  not  yet 
perfectly  understood.  Its  proneness  to  decomposition 
renders  it  very  difficult  of  separation  in  a  pure  state, 
and  on  this  account  a  variety  of  substances  have  been 
described,  differing  somewhat  in  color  and  general 
characters,  and  christened  accordingly.  This  is  the 
reason  we  see  so  many  names  applied  to  the  urine 
pigment. 

The  most  important  results  were  obtained  by  Har- 
ley,1  and  Thudichum."  Harley  succeeded  in  obtaining 
a  "bright  red.  non- cry  stall  izable  compound  "  which 
when  fresh  closely  resembles  red  sealing  wax.  After  a 
while  it  gradually  becomes  darker  and  more  brittle,  but 
does  not  lose  its  general  characters  even  after  twelve 
years  keeping.  He  describes  it  as  being  insoluble  in 
water,  soluble  in  alcohol,  chloroform  and  ether  with  a 
rich  port  wine  color,  according  to  the  amount  dissolved, 
and  soluble  in  fresh  urine  imparting  the  characteristic 
tint  of  normal  high  colored  specimens  of  that  fluid. 
To  this  substance  he  gave  the  name  Urohcematine ; 
for  he  believed  it  to  be  but  the  altered  and  eft'ete  blood 
pigment,  and  its  proportion  in  the  urine  to  be  directly 
connected  with  the  metamorphosis  of  that  substance. 
Urohsematine  contains  both  nitrogen  and  iron.  Ac- 
cording to  its  discoverer  it  is  this  material  which  is  set 
free  and  manifests  itself  in  the  darkening  of  color  when 
nitric  or  any  strong  mineral  acid  is  added  to  urine. 

1  The  Urine  and  its  Derangements.    Phila.,  1872,  p.  96. 
5  British  Med.  Journal,  Nov.  5,  1864. 


ANALYSIS    OF    THE    URINE.  15 

Urochrome  is  the  name  by  which  Tlmdichum 
designates  the  pigment  which  he  succeeded  in  extract- 
ing from  the  urine,  and  it  is  perhaps  the  best  term  to 
remember.  When  separated,  it  presents  itself  as  a 
yellow,  uncrystallizable  mass ;  very  soluble  in  water, 
to  which  it  gives  a  yellow,  urine-color.  Whichever 
the  pigment  is,  it  is  present  in  the  urine  in  something 
like  definite  amount  and  depends  upon  the  proportion 
of  water  whether  it  imparts  a  deep  or  faint  color. 

Excessive  indulgence  in  water,  malt  liquors  and 
wine,  and  diminished  activity  of  the  perspiratory  ap- 
paratus, will  cause  an  increase  of  the  watery  element 
in  the  urine,  and  consequently  more  or  less  dilution. 
Under  these  circumstances  we  would  find  the  color 
light ;  in  some  cases  resembling  pure  water.  The 
converse  of  these  conditions  will  produce  a  contrary 
result.  Urine  voided  by  nervous  and  hysterical  pa- 
tients is  in  large  quantity  and  almost  devoid  of  color. 

Transparency. — Normal  urine  is  perfectly  clear, 
with  the  exception  of  a  small  collection  of  mucus  and 
epithelium  which  nearly  always  collect  at  the  bottom 
of  the  vessel,  but  may  entangle  a  number  of  air-bub- 
bles and  float  as  a  feathery  ball  just  below  the  surface. 

Reaction. — Healthy  urine  has  an  acid  reaction, 
which  is  due  not  to  the  presence  of  any  free  acid,  but 
to  an  acid  salt,  sodium  bi-phosphate.  This  reaction 
may  be  decided  or  faint.  But  it  should  not  be  under- 
stood that  unless  the  urine  is  acid  it  is  abnormal. 
Indeed,  the  reaction  may  vary  within  healthy  limits, 
between  well-marked  alkalinity  and  acidity ;  the 
irregularity  being  to  a  great  extent  due  to  diet. 

The  urine  of  carnivorous  animals  is  acid,  that  of 


16  ANALYSIS    OF    THE     URINE. 

herbivora  is  alkaline,  while  in  omnivora  the  reaction 
can  be  said  to  occupy  a  position  between  the  two.  It 
has  been  ascertained  that  a  vegetable  diet  will  cause 
the  disappearance  of  the  acidity  in  the  carnivora,  and 
a  regimen  of  flesh  induce  an  acid  condition  in  the 
urine  of  herbivora.  Consequently  in  omnivorous  man 
we  are  not  surprised  at  the  unstable  reaction  presented 
by  his  urine,  and  can  account  for  the  changes  by  refer- 
ence to  his  food. 

According  to  most  observers  the  urine  is  alkaline 
after  a  mixed  meal,  but  soon  begins  to  grow  less  so, 
until  the  acid  state  is  restored.  The  acidity  increases 
during  fasting,  and  reaches  its  greatest  degree  of  in- 
tensity after  about  twelve  hours  abstinence  from  food. 
(Roberts.) 

It  is  well  to  note  that  this  variation  is  not  due  to 
any  diminution  in  the  acid  salt  present,  but  simply  to 
a  sudden  accumulation  of  alkaline  ingredients,  the  re- 
sult of  digestion.  For  during  this  process,  all  the  salts 
of  the  organic  acids,  such  as  tartrates,  malates,  citrates, 
and  lactates  are  transformed  into  alkaline  carbonates, 
and  as  such  appear  in  the  urine.  Substances  contain- 
ing these  organic  compounds  are  in  daily  use,  either 
as  food  or  medicine.  Many  fruits  and  vegetables  offer 
familiar  examples,  and  carbonated  mineral  waters  are  a 
common  cause  of  a  temporarily  alkaline  urine. 

Specific  Gravity. — The  specific  gravity  of  nor- 
mal urine  varies  from  1018  to  1025.  These  limits  may 
be  extended  in  individual  cases,  and  in  fact,  depend 
greatly  upon  the  quantity  of  urine  voided.  In  other 
words,  the  specific  gravity  bears  an  inverse  ratio  to  the 
daily  quantity.  Should  we  have  au  increased  flow  of 


ANALYSIS    OF    THE    UKINE.  17 

urine  from  unusual  indulgence  in  drink,  or  from  the 
action  of  any  diuretic,  we  would  not  expect  the  densit}* 
to  equal  that  where  the  same  quantity  of  solid  material 
is  present  in  a  less  amount  of  water.  For  in  diure- 
sis, except  in  a  few  instances  of  disease,  we  merely 
have  the  water  increased,  and  not  the  solid  constitu- 
ents. In  such  cases  we  should  not  be  surprised  to  find 
the  specific  gravity  as  low  as  1010  or  even  1005.  On 
the  other  hand,  where  the  individual  has  taken  little 
or  no  fluid,  or  has  perspired  freely,  or  is  suffering  from 
diarrhoea,  the  urine  would  be  what  we  call  concentrated 
— that  is,  the  normal  amount  of  solid  ingredients,  salts, 
urea,  etc.,  would  be  there  dissolved  in  a  small  propor- 
tion of  water.  And  under  these  circumstances,  the 
specific  gravity  would  be  high — even  1030  would  not 
indicate  disease. 

Daily  Quantity. — The  total  quantity  of  urine 
voided  by  a  healthy  individual  during  twenty-four 
hours  is  estimated  to  be  about  1200  cubic  centimetres. 
This  is  subject  to  variation,  depending  upon  the  quan- 
tity of  fluids  drunk,  the  activity  of  the  perspiratory 
functions,  etc. ;  for  it  is  evident  that  should  there  be  a 
small  proportion  of  fluids  taken  into  the  system,  there 
will  be  less  secreted  by  the  kidneys,  and  vice  versa. 
And  should  perspiration  prevail  to  an  unnatural  de- 
gree, we  would  be  getting  rid  of  the  water  by  another 
channel,  and  would  not  expect  to  find  the  same  volume 
of  urine ;  the  same  may  be  said  of  watery  discharges 
from  the  bowels.  The  kidneys  act  as  regulators  of  the 
water-supply  of  the  blood ;  they  take  from  it  any  ex- 
cess, and  when  there  is  an  insufficiency,  they  demand 
only  enough  to  dissolve  the  solid  constituents  of 


18  ANALYSIS    OF    THE    URINE. 

the  nrine,  and  to  facilitate  their  discharge  from 
the  body. 

The  estimation  of  the  daily  secretion  of  urine  is  one 
of  the  most  important  points  connected  with  its  stud}7. 
But  it  will  readily  be  seen,  from  what  has  been  said, 
that  it  depends  greatly  upon  the  specific  gravity  wheth- 
er the  quantity  voided  has  a  clinical  significance.  In 
fact  the  daily  quantity  and  specific  gravity  of  urine  are 
so  closely  related  that  it  is  difficult  to  treat  of  them 
separately. 

The  solids,  urea  especially,  are  increased  under  the 
influence  of  muscular  exercise,  and  an  animal  diet ; 
while  the  watery  element  is  augmented  by  indulgence 
in  drink,  the  action  of  diuretic  medicines  and  by  nerv- 
ous or  hysterical  conditions.  Variations  in  specific 
gravity,  ranging  from  1005  to  1030,  cannot  be  constant, 
and  not  excite  suspicion  regarding  the  integrity  of  the 
kidneys,  or  some  pathological  condition  of  the  economy. 
To  entitle  them  to  be  considered  under  the  head  of 
normal,  they  must  be  only  temporary  and  easily  re- 
ferred to  some  such  cause  as  has  been  mentioned. 

2.    EFFECTS   OF   REAGENTS    UPON   NORMAL   URINE. 

Cold. — Cold  has  no  visible  effect  upon  urine  of  a 
specific  gravity  at  or  below  about  1020.  But  in  con- 
centrated specimens,  after  cooling,  there  will  be  a  pre- 
cipitate, more  or  less  colored,  which  consists  of  the 
amorphous  urates,  they  being  only  soluble  at  an  ele- 
vated temperature  and  in  an  excess  of  water.  This 
precipitate  first  appears  as  a  cloud  throughout  the 
whole  volume  of  urine,  but  will  gradually  collect  at 


ANALYSIS    OF    THE    URINE.  19 

the  bottom  and  adhere  in  specks  to  the  sides  of  the 
vessel  as  a  tine  powder. 

Such  a  deposit  or  cloudiness  will  disappear  upon 
again  raising  the  temperature  to  that  of  the  body. 

Heat. — Normal  urine  of  a  decided  acid  reaction  is 
unaffected  by  the  application  of  heat.  But  should  the 
reaction  be  faintly  acid,  neutral,  or  alkaline,  heat  will 
cause  a  cloudiness,  due  to  the  precipitation  of  the 
earthy  phosphates  of  lime  and  magnesium. 

These  two  phosphates  are  insoluble  in  a  neutral  or 
alkaline  fluid,  and  are  less  soluble  in  warm  than  in 
a  cold  medium,  and  therefore  will  be  precipitated 
by  heat  if  the  reaction  of»urine  is  even  slightly 
acid. 

Acid. — Vegetable  acids  have  no  immediate  visible 
effect  upon  healthy  urine ;  but  strong  mineral  acids 
deepen  the  color.  If  nitric  or  hydrochloric  acid  be 
added,  in  the  proportion  of  about  one-fourth,  after 
several  hours  minute  but  distinct  dark  brown  crystals 
will  be  seen  clinging  to  the  sides  of  the  test-tube  or 
vessel,  and  collected  at  the  bottom.  These  are  the 
crystals  of  uric  acid  which  have  resulted  from  a  decom- 
position of  the  urates  by  the  acid.  If  the  specimen  be 
concentrated,  voided  after  abstinence,  a  copious  pre- 
cipitate of  urea  nitrate  in  the  form  of  white  shining 
scales  will  follow  the  addition  of  nitric  acid. 

Alkalies. — When  urine  is  rendered  alkaline,  the 
earthy  phosphates  of  lime  and  magnesium  will  be 
precipitated. 

Silver  nitrate  solution  added  to  urine  precipi- 
tates the  chlorides.  But  it  is  necessary  to  previously 
acidify  the  urine  with  a  few  drops  of  nitric  acid,  other- 


20  ANALYSIS    OF    THE    URINE. 

wise  silver  phosphate  will  come  down  in  addition  to 
the  chloride. 

It  is  sometimes  expedient  to  estimate  the  compara- 
tive quantity  of  the  chlorides,  inasmuch  as  it  is  pretty 
well  established  that  they  are  subject  to  great  fluctua- 
tions in  certain  forms  of  disease.  In  pneumonia, 
pleurisy,  and  cholera,  the  chlorides  almost  disappear 
from  the  urine,  and  the  silver  salt  produces  little  or  no 
effect.  But  when  the  attack  begins  to  subside,  this 
reagent  will  detect  the  return  of  the  chlorides.  The 
precipitate  is  a  very  copious  white  cloud  which  turns 
black  on  exposure  to  the  light. 

Barium  chloride  solution  throws  down  the  sul- 
phates from  the  urine.  It  is  well  first  to  add  a 
little  nitric  or  hydrochloric  acid  to  the  urine  as  some 
barium  salts,  other  than  the  sulphates,  are  thereby  dis- 
solved. 

The  variations  in  the  daily  excretion  of  the  sul- 
phates have  little  clinical  significance  as  far  as  known. 

Basic  acetate  of  lead  and  silver  nitrate  pre- 
cipitate the  mucus  and  coloring  matter. 

Many  substances  taken  by  the  mouth  or  injected 
into  the  circulation  subsequently  make  their  appearance 
in  the  urine.  Such  are  potassium  ferrocyanide  which 
can  be  detected  a  few  minutes  after  administration  by 
the  blue  color  which  it  strikes  with  ferric  nitrate; 
iodine  given  either  in  the  free  form  or  in  combination 
is  easily  shown  to  be  excreted  by  the  kidneys.  It, 
however,  never  appears  free  in  the  urine,  and  therefore 
will  not  give  the  characteristic  reaction  with  starch 
until  liberated  by  a  drop  or  two  of  nitric  acid ;  quinine 
passes  out  by  the  urine  and  many  articles  impart  their 


ANALYSIS     OF     THE     URINE. 


21 


peculiar  odor,  as  ether,   cubebs,  copaiba,  turpentine, 
peppermint,  etc. 

CHANGES   WHICH    TAKE    PLACE    IN    URINE    AFTER    BEING 
DISCHARGED    FROM    THE    BODY. 

If  a  specimen  of  urine  be  kept  for  observation,  the 
following  changes  show  themselves: 

At  first,  after  a  period  varying  from  two  da}ys  to  a 
week,  the  acidity  becomes  more  marked,  the  color  is 
darker,  and  crystals  of  uric  acid  and  lime  oxalate 
make  their  appearance.  Even  should  the  urine  be 
faintly  alkaline,  to  commence  with,  and  cloudiness 
exist  from  the  precipitation  of  the  earthy  phosphates, 
it  will  become  acid,  and  the  cloudiness  clear  up,  when 
the  process  continues  as  in  the  other  case.  The  acid- 
ity increases  up  to  a  certain  point,  and  then  begins 
to  grow  less.  It  may  continue  two,  four,  or  seven 
days;  and  Lehman  states,  he  has  observed  the  acid 
reaction  to  increase  for 
two  or  three  weeks,  and 
then  not  disappear  al- 
together until  eight 
weeks.  This  is  the 

ACID      FERMENTATION      of 

urine  (Fig.  1),  which 
although  not  constant, 
will  be  observed  in  the 
majority  of  cases. 

The  acidity  gradually 

j  .     e  '      j    Acid  Fermentation  :  Uric  acid,  octahedra 

becomes       fainter       and     of  lime  oxalate,  and  amorphous  urates. 

fainter,  and  at  length  the  urine   is   neutral.     Now, 
marked    changes   will   be   noticeable.      The  urine  is 


22 


ANALYSIS    OF    THE    URINE. 


cloudy ;  myriads  of  vegetable  organisms  in  rapid 
motion  are  visible  under  the  microscope  (Bacteria). 
Neutrality  gives  place  very  soon  to  alkalinity,  which 
is  advertised  most  emphatically  by  a  putrescent,  am- 
moniacal  odor.  The  uric  acid  crystals  disappear,  and 
others  of  the  ammonio-magnesium  phosphate  are  pro- 
duced. These  crystals  are  large  prisms,  and  can  be 
seen  glistening  on  the  surface  of  the  urine  where  a 
layer  of  brittle  fatty  matter  has  formed.  Dark,  round 
crystals  of  ammonium  urate  may  also  be  seen  with 
the  microscope. 

This  state  of  things  continues  until  the  decomposi- 
tion is  complete.  .  Then  the  ammoniacal  odor  will  no 
longer  be  detected,  and  the  urine  will  have  lost  most 
of  its  color. 

This  constitutes  the 

ALKALINE  FEKMENTATION 

which  is  constant  (Fig.  2) 
The  chemistry  o  f 
these  two  fermentations 
has  been  differently  ex- 
plained ;  but  that  offered 
by  Scherer  is  generally 
accepted  as  correct. 

He  says  that  the  or- 
ganic matters,  the  color- 

Alkaline  Fermentation  :  Crystals  of  am-    jng     matter     and    milCUS, 
monio-magnesium    phosphate,   ammo- 
nium urate  and  deposit  of  amorphous   &Ct    as     catalytic     bodies, 

lime  phosphate.  and  induee  t]ie  fermenta- 

tion whereby  lactic  acid  is  produced.  Just  how  lactic 
is  formed  is  not  well  understood,  but  it  is  certain  that 
it  makes  its  appearance  in  urine  when  allowed  to  stand, 


ANALYSIS     OF    THE     URINE.  23 

in  which  it  could  not  be  detected  when  fresh.  The 
presence  of  lactic  acid  then  decomposes  the  urates, 
whereby  uric  acid  is  set  free  and  makes  its  appear- 
ance as  crystals.  At  the  same  time,  oxalic  acid  must 
be  produced,  for  crystals  of  the  oxalate  of  lime  show 
themselves.  This  oxalate  of  lime  is  very  insoluble, 
and  could  not  have  existed  in  the  urine  before  without 
detection.  Therefore  the  supposition  is  that  oxalic 
acid  is  formed  and  immediately  unites  with  the  lime 
already  present,  for  which  it  has  a  great  affinity. 
Theoretically  we  can  account  for  the  production  of 
oxalic  acid  from  uric  acid.  For  when  this  is  subject 
to  oxidizing  agents  it  is  decomposed,  among  other 
substances,  into  oxalic  acid.  So  much  for  the  acid 
fermentation. 

Now,  we  have  seen  (p.  6)  that  urea  is  converted 
into  ammonium  carbonate  when  in  contact  with  a  de- 
composing organic  substance,  by  the  addition  of  two 
equivalents  of  water. 

Here  then  in  the  urine  we  have  the  conditions  of 
this  decomposition.  The  mucus  gradually  loses  its 
power  of  producing  lactic  and  oxalic  acids,  and  begins 
itself  to  decompose;  and  surrounded  by  water,  the 
arrangement  for  the  transformation  is  complete.  It 
accordingly  takes  place,  and  the  first  effect  of  the  pres- 
ence of  ammonium  carbonate  is  to  neutralize  the  acid 
reaction,  and  then  to  induce  the  alkaline.  Now,  of 
course,  the  earthy  phosphates  are  no  longer  soluble,  and 
render  the  urine  opalescent  by  their  precipitation  ;  the 
uric  acid  crystals  are  dissolved ;  a  scum  of  animal 
matter  intermixed  with  the  amorphous  phosphates 
forms  on  the  surface,  and  very  soon  glistens  with 


24  ANALYSIS    OF    THE    URINE. 

crystals  of  a  new    formation,  ammonia-magnesium 


The  urea  continues  to  be  decomposed,  and  ammo- 
nium carbonate  to  unite  and  form  these  several  new 
substances,  until  there  is  nothing  more  for  it  to  com- 
bine with.  Now  it  escapes  as  gas,  and  the  odor  re- 
minds us  of  that  common  to  public  urinals,  where, 
indeed,  the  same  process  as  just  described  is  going  on. 
At  length,  all  the  urea  is  decomposed,  and  the  evolu- 
tion of  ammonia  ceases.  The  other  substances  either 
remain  unchanged  or  pass  off  in  the  form  of  other 


These  are  the  important  facts  concerning  normal 
urine,  and  a  knowledge  of  them  is  indispensable,  in 
that  if  we  are'  not  acquainted  with  them,  we  certainly 
shall  not  be  prepared  to  detect  and  appreciate  the 
variations  which  constantly  present  themselves,  and 
constitute  an  abnormal  condition. 


PART  II. 

CHARACTERS  OF  ABNORMAL  URINE. 

Odor. — The  odor  of  urine  is  frequently  affected, 
and  is  likely  to  attract  the  attention  of  both  patient 
and  physician,  and  lead  to  its  examination.  Many 
articles  taken  as  food  and  medicine  impart  to  it  an 
odor  peculiar  to  themselves.  Such  are  asparagus, 
onions,  turpentine,  cubebs,  and '  copaiba.  An  am- 
moniacal  odor  tells  the  story  of  decomposition,  and 
urine  containing  pus,  blood  or  albumen  very  soon 
decomposes  and  emits  a  putrid  odor. 

Color. — The  color  of  urine  is  subject  to  many 
changes  depending  simply  upon  the  degree  of  concen- 
tration. In  febrile  diseases,  where  we  have  a  partial 
suppression  of  the  watery  element,  the  secretion  is 
high-colored.  In  diabetes  mellitus,  a  disease  charac- 
terized by  an  inordinate  flow  of  urine  of  high  specific 
gravity,  and  containing  sugar,  the  tint  is  light  and  of 
a  peculiar  straw  color.  In  diabetes  insipid ns  the  urine 
sometimes  resembles  pure  water.  In  albuminuria,  es- 
pecially of  long  standing,  there  is  a  peculiar  whitish, 
albuminous  appearance  which  is  highly  characteristic. 
But  we  should  never  rely  upon  the  color  as  indicating 
the  presence  or  absence  of  albumen. 

Certain  articles  of  food  and  medicine  affect  the 
color  of  the  urine.  Strong  coifee  heightens,  rhubarb 
2 


26  ANALYSIS    OF    THE    UKINE. 

imparts  a  deep  yellow,  and  logwood  gives  it  a  reddish 
hue.  Santonine  renders  it  an  orange  red  when  alka- 
line ;  when  acid,  a  golden  yellow.  Creosote  and  com- 
pounds of  tar  have  been  known  to  cause  the  urine  to 
become  almost  black  ;  and,  lastly,  blood  and  bile  may 
be  present  in  such  quantities  as  to  be  readily  recog- 
nized. 

The  presence  of  bile  may  be  distinguished  from 
the  effects  of  rhubarb  by  the  addition  of  a  little 
liquor  ammonia,  when  the  deep  yellow  of  the  latter 
will  be  converted  into  a  crimson. 

Blue,  green,  and  UacJc  urine  is  occasionally  seen. 
These  remarkable  pigments  occurring  in  this  situation 
were  long  in  being  understood.  But  it  is  now  gene- 
rally acceded  that  they  are  due  to  the  presence  of  in- 
dican,  a  colorless  substance,  identical  with  the  vegeta- 
ble product  from  which  the  indigo-blue  and  indigo- red 
of  the  arts  are  obtained;  and  that  they  represent  but 
different  stages  of  oxidation  of  this  substance.  These 
peculiar  colors  never  appear  in  freshly  voided  urine,  but 
are  always  observed  in  that  which  has  been  allowed  to 
stand  exposed  to  the  air.  It  depends  upon  the  amount 
of  the  coloring-matter  whether  the  entire  volume  of 
the  fluid  will  be  affected.  Sometimes  its  presence  is 
only  manifested  by  the  affinity  which  it  has  for  small 
solid  particles,  such  as  epithelium  debris,  crystals 
and  extraneous  matters,  when  these  substances  will 
be  seen  under  the  microscope  deeply  stained  red, 
blue,  etc. 

The  addition  of  mineral  acids  will  precipitate  these 
pigments  in  urine  in  which  indican  exists. 

Whether  these  extraordinary  appearances  have  any 


ANALYSIS    OF    THE    IJRTNE.  27 

clinical  significance  is  not  decided.  Indican  has  been 
detected  in  many  specimens  of  healthy  urines.  * 

Transparency. — If  a  specimen  of  urine  under 
examination  is  not  clear  and  transparent,  it  should  be 
first  ascertained  whether  there  was  any  turbidity 
when  first  voided;  for  we  have  seen  that  perfectly 
healthy  urine,  when  kept  for  any  length  of  time,  will 
undergo  changes  and  a  marked  opalescence  exist. 
And  abnormal  urine  may  be  at  first  perfectly  clear, 
but  on  cooling  or  standing  exhibit  a  cloudiness  or  de- 
posit. It  is  possible  for  urine  to  be  abnormal,  and  yet 
remain  free  from  turbidity  or  deposit.  For  example, 
albumen  and  sugar  are  perfectly  soluble,  and  can  not 
be  detected  by  simple  ocular  inspection. 

Substances  which  interfere  with  the  transparency 
of  recently  discharged  urine  are,  pus,  blood,  phos- 
phates, urates  (if  the  specimen  is  cool),  chyle,  sper- 
matozoa, and  epithelium. 

The  reader  is  referred  to  each  of  these  under  the 
head  of  "  Urinary  Deposits." 

Reaction.— After  what  has  been  said  concerning 
the  variability  in  the  reaction  of  normal  urine,  it  is 
sufficient  to  add  now  that  when  we  meet  with  a 
patient  whose  urine  is  habitually  or  most  of  the  time 
neutral  or  alkaline,  we  should  regard  him  as  a  subject 
for  treatment. 

Remember  that  the  alkalinity  may  be  due  to  the 
presence  of  the  fixed  salts  of  sodium  and  potassium,  or 

1  Literature  :  Hassall,  Philosophical  Transactions— 1864,  p. 
297.  Harley.  "  Urine  and  its  Derangements."  Phila.,  1872,  p. 
107.  In  Thudiclmm,  "  On  the  Pathology  of  the  Urine,"  Lon- 
don, 1853,  p.  328,  a  very  full  account  is  given. 


28  ANALYSIS     OF    THE     URINE. 

to  the  volatile  one  of  ammonium  ;  that  the  former  are 
derived  from  the  blood  and  the  latter  is  the  result 
of  the  decomposition  of  urea.  These  two  conditions 
can  easily  be  distinguished  apart  by  the  ammoniacal 
odor  which  betrays  the  presence  of  ammonium  car- 
bonate, and  the  fact  that  the  blue  color  which  it 
imparts  to  reddened  litmus-paper  fades  away.  And 
also,  if  the  reaction  be  due  to  this  alkali,  we  shall  n'nd 
crystals  of  the  ammonio-magnesian  phosphate  under 
the  microscope.  (Fig.  6.)  Where  either  the  fixed 
salts  or  the  volatile  one  is  present,  of  course  the  urine 
will  be  turbid  from  a  precipitation  of  the  earthy  phos- 
phates. And  this  precipitation  occurring  in  the  blad- 
der is  likely  to  give  rise  to  a  calculus ;  yet  it  is  pretty 
well  established  that  the  urine  can  remain  alkaline  a 
long  time  from  sodium  and  potassium  carbonates,  and 
a  stone  not  form.  It  is  crystalline  deposits  which  we 
have  to  fear  in  this  regard,  and  as  the  volatile  alkali 
induces  crystalline  formations,  calculi  or  concretions 
are  apt  to  accompany  it. 

Then,  too,  we  may  have  the  urine  abnormally  acid, 
producing  a  scalding  sensation  during  micturition. 
Now,  we  know  what  the  result  is  when  an  acid  is 
added  to  the  urine  outside  the  body:  uric  acid  crystals 
will  be  precipitated.  So  it  is  in  the  bladder  under  the 
same  conditions.  These  crystals  then  accumulate  and 
form  gravel,  which  may  lodge  in  the  kidney,  ureter  or 
bladder.  In  either  situation  it  is  easy  to  comprehend 
how  their  presence  and  increase  in  size  will  cause  re- 
tention and  decomposition  of  the  urine  and  growth  of 
the  original  uric  acid  concretion  by  successive  layers 
of  earthy  phosphates. 


ANALYSIS    OF    THE    UKINE.  29 

Daily  Quantity  and  Specific  Gravity. — We 

have  seen,  in  the  case  of  healthy  urine,  how  closely 
the  specific  gravity  and  daily  quantity  are  related, 
and  that  as  one  increased,  the  other  decreased ;  or,  in 
other  words,  that  they  bore  an  inverse  ratio  to  each 
other.  In  certain  diseased  conditions,  however,  both 
are  increased  and  decreased  together.  The  specific 
gravity  may  be  1030,  and  the  daily  quantity  2  litres 
(60  oz).  Here  we  would  recognize  the  fact  that  there 
is  a  double  waste  of  both  water  and  solids.  And, 
again,  the  specific  gravity  may  be  1006  to  1012,  and  the 
quantity  not  exceed  400  cubic  centimetres  (12  oz).  In 
this  case,  there  is  a  suppression  of  both  elements,  and 
from  retention  of  the  chief  solid  constituent,  urea,  the 
most  fatal  results  may  follow.  There  is  also  a  disease 
— diabetes  insipidus — where  the  daily  quantity  of 
urine  is  enormous,  and  the  specific  gravity  much  below 
the  normal  standard.  This  state  of  things  robs  the  sys- 
tem of  its  proportion  of  water,  occasioning  great  thirst, 
whereby  nature  endeavors  to  counteract  the  drain. 

Here,  then,  as  a  general  rule  in  abnormal  urine,  the 
specific  gravity  and  the  daily  quantity  are  in  direct 
ratio.  When  the  amount  of  water  is  increased,  the 
solids  will  be  also,  and  vice  versa. 

The  specific  gravity  of  urine  will  be  increased  by 
abnormal  ingredients,  such  as  pus,  blood,  mucus,  albu- 
men, and  sugar. 

Great  care  is  necessary  in  collecting  urine  for  ex- 
amination. The  patient  must  be  made  to  pass  the 
entire  secretion  of  twenty-four  hours  in  one  clean 
vessel,  and  from  this  total  quantity  a  portion  must 
be  selected  for  examination,  especially  as  regards  the 
specific  gravity. 


PAKT  III. 

1.  URINARY  DEPOSITS. 

THE  urine  is  subject  to  deposits,  or  collections  of 
solid  and  semi-solid  substances,  which,  on  account  of 
their  weight,  subside  when  undisturbed.  These  de- 
posits consist  of  various  materials,  some  of  which  are 
normal  constituents  of  the  urine,  either  separately  or 
in  combination,  while  others  are  foreign  to  its  compo- 
sition altogether. 

It  will  be  'convenient  to  study  urinary  deposits  by 
dividing  them  into  these  two  classes. 

To  THE  FIRST  CLASS  BELONG  URIC  ACID,  THE  URATES, 
HIPFtfRIC  ACID,  THE  PHOSPHATES,  LIME  OXALATE,  EPITHE- 
LIUM, MUCUS,  AND  PIGMENTS. 

Uric  Acid.— CsH^Og.  This  is  another  nitro- 
genous excrementitious  substance  very  closely  resem- 
bling urea;  its  chief  difference  being  that  it  is  not  so 
prone  to  decomposition,  and  does  not  exist  in  the 
body  in  a  .free  state,  under  normal  conditions. 

Uric  acid  as  soon  as  formed  unites  with  a  portion 
of  the  alkaline  bases  of  the  phosphates  in  the  blood, 
and  appears  in  the  urine  as  sodium  and  potassium  urates. 

It  appropriates  the  sodium  base  in  greater  propor- 
tion and  thus  results  the  formation  of  sodium  l)i- 
phosphate  and  the  acid  reaction  of  the  urine  : 

Sodium  phosphate.     Uric  acid.  Sodium  urate.       Sodium  biphosphate. 

Nag  [IPO*  +  C5H4N408  =  NaC5H8N4O8  +  KaH2PO4. 


ANALYSIS     OF    THE     URINE. 


By  oxidation  uric  acid  is  converted  into  urea  and 
oxalic  acid. 

There  are  various  pathological  conditions,  not  well 
understood,  which  give  rise  to  free  uric  acid  in  the 
urine.  Slight  derangements  in  the  digestive  process, 
an  excess  of  nitrogenous  food  or  a  want  of  alkalies  will 
cause  it  to  appear.  "When  free  it  invariably  presents 
itself  as  crystals,  in  most  instances  of  a  brown  color. 
We  have  seen  that  uric  acid  is  set  free  during  the  acid 
fermentation  of  urine,  and  that  it  is  caused  by  the 
development  and  action  of  lactic  acid,  which  decom- 
poses the  urates.  We  can  accomplish  the  same  result 
by  adding  any  strong  acid  to  a  test-tube  containing 
urine,  and  allowing  it  to  remain  quiet  for  several 
hours.  Then  the  characteristic  uric-acid  crystals  will  be 
seen  attached  to  the  sides  and  collected  at  the  bottom. 

The  dark  brown  color  which  almost  invariably  dis- 
tinguishes these  crystals  is  derived  from  the  coloring 
matter  of  the  urine,  for  which  they  have  a  great 
affinity.  Yet  we  some-  FIO.  3. 

times  see  almost  colorless 
and  pure  crystals  of  uric 
acid ;  and  these  are  apt 
to  be  small  square  plates 
and  diamonds. 

The  formation  of  crys- 
tals of  uric  acid  may 
take  place  in  the  uri- 
nary passages,  not  only 
as  a  result  of  fermen- 
tation, but  spontaneous-  uric  Acid, 
ly.  as  just  indicated.  In  either  case,  gravel  and  calculi 


i)Z  ANALYSIS    OF    THE    URINE. 

are  likely  to  result.  It  is  very  important  to  know 
whether  a  deposit  in  a  specimen  under  observation 
has  taken  place  previous  or  subsequent  to  its  discharge. 

A  deposit  of  uric  acid 
is  of  a  dark  brown  co- 
lor, or  if  pure,  it  is  a 
white,  glistening  sedi- 
ment, and  under  the 
microscope  presents  the 
greatest  variety  of  crys- 
talline forms.  In  fact, 
so  numerous  are  the 
shapes  and  arrangements 
of  these  crystals,  that  it 
UricAcid>  is  very  difficult  to  de- 

scribe them.  Yet  when  familiar  with  urinary  crys- 
tals, they  are  not  likely  to  confuse  one.  For  it  is  only 
necessary  to  be  able  to  recognize  the  other  crystalline 
deposits,  which  vary  little  or  none ;  and  then  when  a 
brown  crystal  of  an  unusual  form  is  seen,  it  is  pretty 
safe  to  pronounce  it  uric  acid.1  The  most  common  mi- 
croscopic appearances  are  represented  in  Figs.  3  and  4% 
TESTS. — Uric  acid  is  insoluble  in  water,  alcohol, 
and  ether.  It  is  soluble  in  an  alkali,  especially  at  a 
high  temperature,  and  in  sulphuric  acid  without  de- 
composition, for  it  can  be  reprecipitated  simply  by  the 
addition  of  water. 

There  is  a  beautiful  test  for  uric  acid  called  the 

1  Where  any  doubt  exists  as  to  the  identity  of  a  colored  crys- 
tal it  should  be  dissolved  in  a  little  warm  alkali  and  then  treated 
with  hydrochloric  acid  ;  when  if  it  be  uric  acid  minute  colorless 
plates  will  be  detected  after  some  hours,  under  the  micro- 
scope. 


ANALYSIS     OF     THE     UKIXE.  33 

murexid  test.  Place  the  uric  acid  in  a  clean  white 
porcelain  capsule,  and  add  a  drop  or  two  of  nitric 
acid  ;  then  evaporate  over  the  flame  of  a  spirit-lamp. 
When  the  nitric  acid  has  been  driven  off,  there  will  a 
pink  stain  show  itself,  which  on  the  addition  of  a 
little  liquor  ammonia,  assumes  a  beautiful  purple  color. 

Urates. — We  have  just  seen  that  uric  acid,  simul- 
taneously with  its  formation,  unites  with  a  part  of  the 
loosely  combined  sodium  and  potassium  of  the  phos- 
phates, and  forms  sodium  and  potassium  urates.  (It  is 
a  question  whether  the  urine  contains  lime  and  ammo- 
nium urates.)  The  urates  constitute  the  most  frequent 
deposit  met  with  in  the  urine.  They  appear  as  a  dense 
cloud,  which  collects  at  the  bottom  of  the  urine-glass, 
and  at  the  same  time  dusts  the  sides  over  with  a 
powdery  film.  The  color  of  the  precipitate  varies 
from  a  white  to  a  red,  according  to  the  concentration 
of  the  urine,  these  substances  having  a  great  affinity 
for  the  coloring  matter. 

The  urates  have  very  much  the  same  characters, 
being  soluble  in  an  excess  of  water  at  a  low  temper- 
ature, and  soluble  in  very  small  proportion  of  this 
medium  under  the  influence  of  heat.  It  is  this  reason 
that,  however  concentrated  the  urine  may  be  when 
voided,  it  is  never  turbid  with  the  urates  :  but  in  a 
short  time,  the  temperature  falling,  a  cloudiness  is  visi- 
ble, followed  shortly  by  a  copious  deposit. 

Knowing,  then,  that  the  urates  are  precipitated 
when  the  urine  is  deficient  in  water,  we  can  under- 
stand how  abstinence  from  drink,  profuse  perspira- 
tion, a  watery  discharge  from  the  bowels,  or  any 
influence  which  lessens  the  normal  quantity  of  water 


34  ANALYSIS    OF    THE     UKINE. 

in  the  system,  or  turns  it  away  from  the  kidneys,  will 
have  the  effect  of  concentrating  the  urinary  secretion, 
and  causing  the  urates  to  appear  when  the  urine  cools. 
Yet,  a  deposit  of  the  urates  is  not  on  all  occasions 
due  to  a  suppression  of  the  watery  element ;  there  are 
various  disturbances  of  the  system  wherein  their  pro- 
duction and  excretion  is  enhanced. 

In  fevers,  heart  and  liver  diseases,  the  urates  are 
deposited  and  are  high  colored.  Irregularity  in  the 
digestive  apparatus  often  induces  their  precipitation, 
and  we  often  encounter  a  copious  white  deposit  of 
them  in  the  urine  of  teething  children. 

A  deposit  of  urates  is  almost  always  amorphous, 
though  sometimes  crystals  of  sodium  urate  are  formed, 
and  in  the  alkaline  fermentation,  ammonium  urate. 
Crystals  of  sodium  mate  are  met  with  in  the  chalky 
concretion  common  in  the  bodies  of  gouty  persons, 
and  also  in  the  urine  of  such.  In  the  concretions  they 
are  needle-shaped,  arranged  in  rosettes  of  various 
s.  degrees  of  perfection  : 

while  in  the  urine  they 
assume  a  globular  form, 
with  irregular  projec- 
tions along  the  surface. 
(Fig.  5,  J.) 

Ammonium  urate 
crystals  appear  as  very 
dark,  spherical  masses, 

anc^ as  dumb-bells.  They 

form   during  the   alka- 

«.  Ammonium  urat;e.  ,.  -,  .   . 

b.  sodium  urate.  line  decomposition,  and 

can  only  be  seen  under  that  condition.  (Fig.  5,  a.)     The 


ANALYSIS    OF    THE     URTNE.  35 

pathological  indications  of  the  crystalline  urates  are 
much  more  important  than  those  attaching  to  the 
amorphous  deposit,  in  that  the  former  are  deposited  in 
the  urinary  tract,  while  the  latter  seldom  are. 

A  urine  showing  a  precipitation  of  urates  is  always 
acid. 

TESTS. — The  urates  disappear  at  a  temperature  of 
100  F.  They  are  soluble  in  an  alkali.  The  addition 
of  an  acid  decomposes  them,  with  the  liberation  of 
uric  acid  which  very  soon  crystallizes.  This  pro- 
cess is  very  interesting  to  observe  under  the  micro- 
scope. 

The  murexid  test  for  uric  acid  is  applicable  to  the 
urates. 

Hippuric  Acid. — CgHaNOa.  Hippuric  acid  was 
formerly  believed  to  exist  only  in  the  urine  of  her- 
bivora ;  but  it  is  now  generally  conceded  that  it  is 
quite  constant,  in  small  proportion,  in  the  renal  excre- 
tion of  man.  It  increases  under  the  influence  of  a 
vegetable  diet,  and  can  be  made  to  appear  in  large 
amount  by  taking  benzoic  acid  by  the  mouth — this 
substance  being  transformed  into  hippuric  acid.  Hip- 
puric has  very  similar  characters  to  uric  acid,  and  their 
compounds  possess  no  important  distinctions. 

The  hippurates  owing  to  their  solubility  never 
appear  as  deposits  in  urine.  13ut  they  are  readily  de- 
composed by  acids,  when  the  hippuric  acid  will  form 
a  crystalline  deposit  in  very  concentrated  solutions. 
Crystals  of  hippuric  acid  may  then  be  encountered 
during  the  acid  fermentation  of  urine  or  as  a  result 
of  the  addition  of  an  acid  in  our  manipulations. 
The  acid  is  easily  obtained  from  the  urine  of  the 


36  ANALYSIS    OF    THE    URINE. 

horse,  or  by  administering  a  quantity  of  benzoic  acid 
to  a  man  or  dog.  Then  upon  evaporating  and  adding 
hydrochloric  acid,  a  visible  deposit  of  hippuric  acid  is 
obtained,  which  under  the  microscope  is  seen  to  con- 
sist of  long  transparent  prisms  and  needles. 

TESTS. — These  crystals  may  be  mistaken  for  those 
of  the  phosphates.  In  such  a  case  a  drop  of  hy- 
drochloric acid  will  decide  the  question;  the  phos- 
phates being  thereby  dissolved  and  hippuric  acid  un- 
affected. 

To  the  taste  they  are  bitter.  The  watery  solution 
reddens  litmus  paper,  showing  it  to  be  a  stronger  acid 
than  uric. 

Phosphates. — The  alkaline  phosphates  of  sodium 
and  potassium,  owing  to  their  solubility,  are  never 
met  with  as  deposits  in  urine. 

It  is  the  earthy  phosphates  of  lime  and  magnesium 
with  which  we  have  to  deal  as  precipitates,  and  which 
are  so  frequently  encountered.  They  present  them- 
selves in  three  forms  :  the  amorphous  lime  phosphate, 
the  crystalline  lime  phosphate,  and  the  ammonio-mag- 
nesium  phosphate. 

Amorphous  lime  phosphate,  with  a  small  amount 
of  magnesium  phosphate,  is  the  common  deposit  of 
urine  rendered  alkaline  by  a  vegetable  diet  or  the 
administration  of  vegetable  acids  and  their  salts.  It 
frequently  becomes  abundant  after  nervous  exhaustion, 
as  loss  of  sleep,  mental  application,  etc. 

This  deposit  renders  the  urine  milky  when  voided, 
and  subsequently  subsides  as  a  not  very  abundant 
white  collection  at  the  bottom  of  the  vessel. 

Crystalline  lime  phosphate  is  sometimes  met  with. 


ANALYSIS     OF    THE     UHINK.  37 

The  crystals  are  perfectly  colorless  needles  arranged 
in  radiating  bundles.  They  are  sometimes  called  the 
stellar  phosphate. 

Roberts  considers  their  presence  indicative  of  some 
grave  disorder,  having  discovered  them  in  diabetes, 
cancer,  and  phthisis.  It  may,  however,  appear  in 
normal  urine  when  much  lime  has  been  introduced 
into  the  system. 

The  ammonio-magnesian  phosphate  is  a  crystalline 
deposit,  the  result  almost  alwa}Ts  of  the  alkaline  fer- 
mentation and  the  decomposition  of  urea.  This  de- 
posit very  seldom  takes  place  inside  the  body,  and 
when  it  does,  it  is  the  result  of  retention  of  urine. 
Under  these  circumstances,  decomposition  takes  place, 
and  the  ammonium,  which  is  one  of  the  results,  unites 
with  the  magnesium  already  present,  and  the  deposit* 
is  formed.  The  ammonium  normally  present  in  the 
urine  is  seldom  sufficient  to  constitute  this  deposit 
without  the  decomposition  of  urea. 

The  earthy  phosphates  are  only  soluble  in  an  acid 
fluid,  the  acid  salt  sodium  biphosphate  holding  them 
in  solution  in  the  urine.  Whenever  the  urine  becomes 
neutral  or  alkaline  from  a  diminution  in  the  quantity 
of  uric  acid  or  from  an  excess  of  alkaline  ingredients 
in  the  blood,  or  from  retention  and  consequent  de- 
composition, the  earthy  phosphates  will  be  thrown 
down. 

"Notwithstanding  the  great  amount  of  literature  on 
tiie  subject,  "phosphaturia,"  with  the  exception  of 
that  induced  by  the  alkaline  decomposition,  has 
not  much  clinical  significance.  Under  the  micro- 
scope the  phosphates  appear  as  amorphous  gran- 


38 


ANALYSIS    OF    THE    URINE. 


Ammonio-maguesian  phosphate. 


ules  and,  in  the  case  of  the  ammonio-magnesian, 
large  glistening  prismatic  crystals.  When  crj-stallization 
takes  place  rapidly  we  of- 
ten see  beautiful  feathery 
forms  like  those  represent- 
ed in  the  lower  portion  of 
the  accompanying  figure. 
TESTS.  —  The  earthy 
phosphates  are  soluble  in 
an  acid  solution;  and 
are  less  soluble  in  hot 
than  cold  media.  A  drop 
or  two  of  any  acid  will 
cause  them  to  disappear. 
Lime  Oxalate. — Lime  oxalate  is  found  in  urine 
as  a  result  of  the  acid  fermentation,  and  also  in  per- 
fectly fresh  and  undecomposed  specimens.  Indeed, 
the  formation  may  take  place  in  the  body.  It  is 
claimed  by  many  that  oxalic  acid  is  a  normal  constitu- 
ent of  the  urine,  and  that  it,  like  the  other  ingredients, 
is  subject  to  variation,  and  when  furnished  in  a  little 
more  than  the  usual  amount,  it  unites  with  the  lime 
already  present,  and  the  oxalate  is  the  result.  It  is 
probably  derived  from  uric  acid  by  oxidation. 

It  appears  as  a  whitish  powder,  and  never  is  very 
abundant. 

A  great  deal  has  been  said  concerning  the  signifi- 
cance of  oxalate  of  lime  in  the  urine,  under  the  heads 
of  "  Oxaluria  "  and  «  Oxalic  Diathesis." 

A  long  train  of  symptoms  were  attributed  to  its 
presence  in  the  urine,  such  as  nervous  prostration, 
despondency,  loss  of  sexual  power  in  the  male,  etc. 


ANALYSIS    OF    THE     URINE.  39 

And  although  there  is  not  as  much  interest  in  the  sub- 
ject now  as  formerly,  I  'have  reason  to  believe  that  the 
doctrine  is  not  altogether  false. 

But  the  chief  significance  which  attaches  to  this 
deposit  is  the  possibility  of  the  formation  of  a  stone ; 
and  as  this  variety  is  very  hard  and  rough,  it  is  espe- 
cially dreaded. 

TESTS. — A  deposit  of  lime  oxalate  is  always  crys- 
talline, and  the  microscopic  appearances  are  sufficient 
to  distinguish  it.  The  crystals  are  of  two  kinds, 
octahedra  and  dumb-bells,  each  being  colorless  and 
transparent. 

The  octahedra,  which  are  by  far  the  most  common, 
consist  of  two  pyramids  placed  base  to  base  and  vary- 
ing in  size  from  about  101o0  of  an  inch  to  that  which 
may  be  seen  by  the  un- 
aided eye. 

The  dumb-bells  are 
highly  characteristic. 
Occasionally  an  oval 
mass  is  seen  which  ap- 
pears to  be  a  dumb- 
bell in  process  of  forma- 
tion. 

Lime  oxalate  is  solu- 
ble in  strong  mineral 

•  j  Lime  oxalate  :    Octahedra   and   dumb- 

acids.  bells> 

Epithelium. — Every  specimen  of  urine  contains 
some  epithelium,  which  in  certain  diseases  of  the  kid- 
neys and  urinary  passages  is  greatly  increased.  In  the 
healthy  state,  we  find  that  from  the  bladder  in  the 
greatest  amount ;  and  in  the  female,  vaginal  epitheli- 


40  ANALYSIS    OF    THE    UKINE. 

um  will  be  mingled  with  the  urine,  if  great  care  is  not 
exercised. 

As  the  gerii to-urinary  apparatus  is  lined  with  epi- 
thelium of  different  forms  throughout  its  extent,  it  is 
well  to  know  what  are  the  peculiarities  which  distin- 
guish that  of  one  region  from  that  of  another. 

Vaginal  epithelium  is  very  common  in  the  urine  of 
women,  especially  when  there  is  any  discharge  from 
the  vagina  or  uterus.  It  is  easily  recognized  by  its 
large  size,  thinness,  wa- 
vy outline,  and  disposi- 
tion to  fold  upon  itself. 
(Fig.  8,  5.)  The  female 
urethra  contains  very 
similar  forms,  but  they 
are  somewhat  smaller. 

The  urethra  is  lined 
by  epithelium,  which 
differs  in  the  spongy 
and  prostatic  portions. 

Epithelium  :    a,  Bladder :    6,  Vaginal :    -„ 

Cf  Ecnai.  From  the  meatus  to  the 

prostatic  region,  the  cells  are  round  and  oval.  About 
the  prostate,  they  are  spindle-shaped,  caudate,  and 
irregular. 

In  the  Uadder,  the  size  is  increased,  and  they  are 
often  seen  still  united  by  their  edges.  (Fig.  8,  a.} 
Those  from  the  ureters  possess  the  same  characters, 
only  are  of  smaller  size. 

The  pelvis  of  the  kidney  contains  small  round  and 
oval  cells,  of  the  flat  variety,  which  are  a  little  larger 
than  tubular  epithelium. 

The  epithelium  of  the  kidney  tubules  is  a  very 


ANALYSIS     OF    THE     URIXK.  41 

complicated  one,  but  it  is  sufficient  for  our  purposes  to 
know  that  it  is  spherical,  about  twice  as  large  as  a 
blood-globule,  from  which  it  may  be  distinguished, 
should  any  doubt  arise,  by  its  nucleus.  It  usually 
comes  away  from  the  kidney  adhering  to  fibrinons 
moulds  of  the  tubes,  but  may  often  be  seen  floating 
free  in  the  urine.  (Fig.  8,  c.) 

When  epithelium  is  present  in  abundance,  it  will 
be  accompanied  by  an  increase  in  the  natural  amount 
of  mucus,  and  the  two  substances  settle  to  the  bottom 
of  the  urine-glass,  intimately  mingled.  Under  the 
microscope,  patches  of  epithelium-cells  will  be  seen 
bold  together  by  the  adhesive  mucus. 

Epithelium  appears  in  the  urine  as  a  result  of  any 
inflammation  or  mechanical  irritation  of  the  mucous 
membrane  of  the  urinary  tract. 

Mucus. — There  is  always  a  small  amount  of  mucus 
in  healthy  urine,  especially  in  the  first  passed  in  the 
morning.  It  is  to  the  presence  of  mucus,  however 
limited  in  quantity,  that  the  decomposition  of  urine 
is  due.  For  if  the  urine  be  filtered,  it  may  be  kept 
for  an  indefinite  time  without  any  change  manifesting 
itself.  (Scherer.) 

Mucus  appears  as  a  deposit  at  the  bottom  of  the 
glass,  or  may  entangle  air-bubbles  and  float  just  below 
the  surface.  It  has  the  color  of  the  urine  contain- 
ing it,  and  when  separated  on  a  filter,  is  perfectly 
transparent  and  glairy.  All  amorphous  and  crystal- 
line deposits,  blood,  pus,  casts,  etc.,  become  mingled 
with  it  and  interfere  with  the  transparency,  or  may 
mask  its  presence. 

Excessive  secretion  of  mucus  may  be  the  result  of 


42  ANALYSIS     OF     THE     URINE. 

mechanical  irritation,  ammoniacal  decomposition  of 
the  urine  in  the  bladder,  or  chronic  inflammation. 
Sometimes  there  is  such  an  amount  produced  that  the 
whole  volume  of  urine  will  be  rendered  semi-solid, 
and  will  rope  like  the  white  of  egg. 

TESTS. — Mucus  is  liable  to  be  confounded  with  pus, 
especially  when  colored  by  amorphous  deposits.  It 
may  be  distinguished  from  pus  by  its  ropy  and  viscid 
nature,  and,  best  of  all,  by  its  appearance  under 
the  microscope,  mucus  having  no  corpuscular  ele- 
ments. 

Pigments. — We  frequently  encounter  peculiar 
little  bodies  under  the  microscope,  possessing  indefi- 
nite shapes  and  appearances,  and  attracting  the  atten- 
tion of  the  observer  by  their  high  color,  being  either 
red,  dark  brown,  or  yellow. 

They  sometimes  resemble  epithelium,  but  show  no 
nucleus;  again,  they  may  be  an  irregular  mass,  unlike 
any  thing  we  are  familiar  with.  What  their  origin 
and  significance  is,  is  an  unsettled  question.  They  are 
likely  to  occur  in  any  specimen  of  urine,  but  Roberts 
states  that  in  several  cases  of  chronic  JBright's  disease, 
he  has  noticed  a  great  increase  of  them. 

It  has  been  thought  that  they  might  be  epithelium- 
scales,  stained  by  the  coloring  matter  of  the  urine,  as 
this  is  known  to  undergo  changes  whereby  other  colors 
are  produced.  The  oxidation  of  indican  probably  has 
something  to  do  with  the  matter. 

One  other  source,  and  a  common  one,  of  these  col- 
ored specks  under  the  microscope,  it  is  important  to 
guard  against :  it  is  that  they  may  exist  in  the  glass 
slides  or  covers;  for  these  articles  are  polished  with 


ANALYSIS     OF    THE     URINE.  43 

a  red  powder,  particles  of  which  become  imbedded  in 
its  minute  irregularities. 


II. 

SECOND  CLASS  OF  DEPOSITS  :  those  which  are  foreign 
to  the  composition  of  the  urine  under  any  form. 

This  class  differs  from  the  preceding  in  that  most 
of  the  deposits  have  a  pathological  significance. 

The  following  are  included  under  this  head  :  BLOOD, 

CASTS,  PUS,  OIL,  CHYLE,  SPERMATOZOA ,  CYSTINE,  KEISTINE, 
CONFERVOID  VEGETATIONS,  and  BACTERIA. 

Blood. — Blood  may  be  mingled  with  the  urine 
from  either  of  the  organs  through  which  it  has  to  pass. 
Urine  containing  blood  may  or  may  not  give  evidence 
of  it  when  first  passed.  It  depends  upon  the  quanti- 
ty of  blood  present  whether  there  will  be  any  distinc- 
tion as  regards  color. 

If  the  quantity  is  small,  we  probably  will  not  sus- 
pect its  presence  until  the  urine  has  remained  undis- 
turbed some  hours  in  a  urine-glass,  when  a  red  line  or 
layer  will  be  discernible  at  the  bottom.  (It  must  not 
be  confounded  with  uric  acid,  which  is  of  a  dark  brown 
color,  instead  of  a  blood-red.)  The  deposit  consists  of 
the  red  corpuscles. 

We  may  have  urine  stained  with  blood,  and  yet 
containing  no  corpuscles,  or  at  least  a  very  few.  Thus 
the  blood  may  be  represented  in  the  urine  under  these 
two  conditions :  hcematuria,  where  the  elements  of 
the  blood  are  present  under  their  natural  forms; 
hcematinuria,  where  the  red  corpuscles  appear  to 
have  disintegrated  or  dissolved,  and  only  a  few  per- 


44  ANALYSIS     OF"  THE     URINE. 

feet  ones  can  be  found.  It  is  necessary  to  consider 
these  apart. 

Ifcematuria. — In  hrematuria  the  red  corpuscles 
are  present,  and  impart  to  the  urine  a  more  or  less 
red  or  smoky  hue.  The  corpuscles  have  escaped  from 
the  circulation  as  a  result  of  ruptured  vessels  some- 
where in  the  urinary  tract,  which  may  be  due  to  vio- 
lence, as  falls  or  blows,  Bright's  disease,  temporary 
congestion,  ulcers,  abscess,  and  the  lacerations  attend- 
ing the  presence  of  stone  and  gravel.  Hsematuria  is 
common  in  some  irruptive  fevers,  notably  scarlet;  it 
is  very  frequently  induced  by  the  administration  of 
turpentine  and  cantharides,  and  it  may  occur  vica- 
riously for  menstruation  and  a  hemorrhoidal  flux. 
The  urine  of  women  is  extremely  liable  to  contain 
blood  during  the  menstrual  period,  from  admixture 
outside  the  body. 

Hcematinuria. — This  curious  affection  is  charac- 
terized \>y  a  chocolate-colored  urine,  due  to  the  pres- 
ence of  haemoglobin,  which  had  transuded  through  the 
blood-vessels,  and  appears  independent  of  the  blood 
corpuscles  which  are  thought  to  have  dissolved.  Dark 
granular  and  hyaline  casts  are  frequently  found,  as 
well  as  amorphous  matter  and  octahedra  of  lime 
oxalate. 

The  occurrence  of  the  blood  coloring  matter  in  the 
urine  independent  of  the  corpuscles  characterizes  a 
disease  which  has  recently  received  considerable  atten- 
tion. The  chief  features  of  hsematinuria  are  first  of 
all,  its  intermittent  character;  and  second,  the  total 
absence,  in  the  majority  of  cases,  of  symptoms  attrib- 
utable to  disorders  of  the  urinary  apparatus. 


ANALYSIS    OF    THE    UKINE.  45 

In  short,  the  general  opinion  is  that  it  is  a  form 
of  malarial  poisoning,  and  it  is  consequently  fre- 
quently spoken  of  as  malarial  or  paroxysmal  haema- 
turia. 

Whether  there  is  a  marked  absence  of  the  red 
corpuscles  in  this  disease  is  a  question  upon  which 
authors  disagree.  In  a  case  under  my  own  observa- 
tion there  was  never  any  scarcity  of  them  during  the 
attacks.  Dr.  Legg 1  attributes  the  failure  of  some  to 
find  them  to  their  rapid  disappearance  in  urine  when 
kept  for  some  hours.  The  urine  contains  albumen 
during  the  paroxysms,  but  is  generally  entirely  free 
from  it  in  the  intervals. 

TESTS. — A  rupture  permitting  the  escape  of  the 
blood  corpuscles  will,  of  course,  allow  of  the  passage 
of  albumen,  arid  consequently  we  always  find  this  sub- 
stance in  haematuria.  The  corpuscles  themselves  are 
albuminoid,  and  were  there  no  free  albumen  present, 
would  respond  to  the  heat  and  nitric  acid  tests.  But 
the  most  positive  proof  of  the  presence  of  blood  is 
furnished  by  the  appearance  of  the  sediment  under 
the  microscope.  This  instrument,  with  a  £-inch  lens, 
will  reveal  the  corpuscles.  They  are  bi-concave  discs, 
about  -joW  °f  an  inca  in  diameter.  By  careful  focus- 
ing, their  form  can  be  distinguished,  the  outline  and 
centre  never  being  equally  distinct  at  the  same  time ; 
then  if  a  current  be  excited  in  the  drop  under  the  eye, 
by  touching  the  side  of  the  thin  glass  cover  with  a  bit 

1  On  Paroxysmal  Ilammturia :  St.  Bartholomew's  Hospital 
Reports.  London.  1874.  Here  a  full  resume  of  the  subject  is 
given. 


46  ANALYSIS     OF     THE     UEINE. 

of  blotting-paper,  the  corpuscles  will  roll  over  and 
FIG.  9.  over  and  show  their  thin 

edges  and  concave  sur- 
faces. All  these  points 
are  illustrated  in  Fig. 

There  are  changes, 
however,  which  blood 
corpuscles  undergo  when 
subjected  to  unnatural 
influences.  In  the  blood 
serum,  they  maintain 


Blood  Corpuscles  :  a,  Normal ;  b,  Swol-    t]lejr  snape  an(J    gjze    ^llt 
len  by  absorption  ;  c,  Shriveled  from 

lack  of  water.  immersed    in    a   watery 

solution  like  urine,  they  immediately  begin  to  absorb 
water,  and  very  soon  have  swollen  to  twice  their 
natural  size,  lost  their  color  and  bi-concave  character, 
and  have  become  spherical.  When  allowed  to  dry, 
they  shrivel  and  become  so  irregular  that  should  one 
not  be  familiar  with  the  fact,  he  might  not  suspect 
their  presence.  When  in  this  condition,  the  addition 
of  a  drop  of  water  containing  a  little  common  salt  will 
cause  them  to  assume  something  of  their  original  shape. 
In  the  event  that  we  should  fail  to  detect  any 
corpuscles  when  blood  is  suspected,  they  having  dis- 
solved or  never  having  been  present,  it  is  only  neces- 
sary to  apply  heat  and  nitric  acid.  Then  if  there  be 
haemoglobin  present,  it  will  assume  a  very  dark  color, 
become  entangled  with  the  coagulated  albumen,  and 
if  allowed  to  rest,  will  collect  at  the  bottom  of  the 
test-tube  as  a  chocolate-colored  mass,  with  the  trans- 
parent urine  above. 


ANALYSIS    OF    THE     DEINE.  4:7 

The  spectroscope  will  detect  exceedingly  small 
quantities  of  haemoglobin  in  solution,  and  should  any 
doubt  exist  as  to  whether  blood  is  present  in  a  speci- 
men of  urine,  this  instrument  will  very  readily 
determine.1 

Casts. — Casts  are  moulds  of  the  uriniferous  tubules. 
The  kidney  is  largely  supplied  with  capillaries,  which 
form  a  complex  network  about  the  tubules,  and  any 
congestion  of  the  organ  is  very  apt  to  result  in  an  exu- 
dation from  the  blood-vessels  into  these  little  canals,  of 
a  peculiar  substance,  the  composition  of  which  is  not 
well  understood.  This  substance  has  the  property  of 
spontaneous  coagulation,  and  thus  adapts  itself  to  the 
shape  and  size  of  the  tube,  and  the  urine  collecting  be- 
hind, washes  it  out,  and  it  subsequently  appears  in  the 
urine  as  a  cast.  The  pressure  which  induces  this  exu- 
dation is  also  sufficient  to  cause  a  transudation  of  the 
liquid  portion  of  the  blood ;  and  it  results  that  albu- 
minuria  always  exists  where  casts  are  formed. 

Casts  are  not  all  of  the  same  diameter.  One  reason 
for  this  is,  that  the  tubules  themselves  vary  in  size  in 
different  parts  of  their  course.  Another  cause  de- 
pends upon  the  fact  that  in  certain  affections  of  the 
kidney,  the  epithelium  lining  the  tubules  is  detached 
arid  voided  with  the  urine.  Now,  a  tubule  thus  de- 
nuded is  larger  than  it  was  previous  to  the  shedding 
of  its  lining,  and  consequently  will  afterward  form  a 
larger  cast. 

Casts  differ  as  regards  appearance.   The  coagulable 

1  See  Dalton's  Physiology.  Phila. .  1875.  P.  248.  And  a 
paper  by  the  author,  The  Spectroscope  ;  its  Value  in  Medical 
Science.  Trans.  N.  Y.  Academy  of  Medicine.  1876. 


48  ANALYSIS    OF    THE    URINE. 

matter  which  transudes  into  the  tubules  is  perfectly 
transparent  and  structureless,  so  far  as  has  been  ascer- 
tained. The  theory  is,  that  this  material  when  col- 
lected in  the  tubules  fills  and  distends  them  ;  this  dis- 
tention  causes  pressure  upon  the  epithelium  lining 
which  adheres  to  and  sinks  into  it  to  a  certain  extent. 
Now,  when  the  cast  is  washed  out  by  the  pressure  of 
urine  from  behind,  it  pulls  slightly  upon  its  epithelial 
attachments,  and  if  the  cells  be  detached  or  detachable, 
through  degeneration,  they  must  come  along  with  it. 

It  follows,  then  from  the  above  description  that  if 
the  kidney  is  not  diseased  to  such  an  extent  as  to  allow 
of  desquamation  of  its  epithelium,  or,  on  the  other 
hand,  if  the  epithelium  has  been  previously  shed, 
leaving  the  tubule  bare,  the  cast  will  come  away  and 
appear  in  the  urine  unaltered  as  regards  its  structure, 
and  will  appear  as  a  transparent  mould  of  a  renal 
tubule.  These  we  call  hyaline  casts. 

It  is  not  necessary,  after  the  above  explanation,  to 
say  more  than  that  when  the  epithelium  does  show 
itself  adhering  to  the  cast,  we  recognize  another  va- 
riety— namely,  epithelium  casts. 

And  suppose  these  epithelium  cells  to  have  under- 
gone a  fatty  degeneration,  we  should  then  have  fatty 
casts.  Go  a  little  further,  and  imagine  the  epithelium 
to  have  suifered  what  is  known  as  a  granular  degene- 
ration, then  we  should  lind  granular  casts. 

Besides  these  varieties,  we  meet  with  several  others, 
having  nothing  to  do,  however,  with  the  epithelium 
element.  These  are  Hood,  pus,  and  waxy  casts. 

As  it  is  my  purpose  to  give  a  few  hints  respecting 
the  practical  bearing  of  the  subjects  treated  of  in  this 


ANALYSIS     OF    THE     URINE. 


49 


manual,  it  will  be  necessary  to  glance  at  each  one  of 
these  casts  separately. 

Hyaline  Casts,  as  their  name  implies,  are  struc- 
tureless and  transparent.  They  vary  in  diameter  from 
the  width  of  one  blood  corpuscle  to  that  of  three. 
Their  length  is  not  definite.  Being  transparent,  they 
are  difficult  to  find,  and  on  this  account  are  often 
overlooked. 

The  mode  of  formation  of  these  casts  has  been 
stated  above ;  and  therefore  when  they  are  small,  it  is 
fair  to  suppose  the  kidney  yet  to  be  comparatively 
sound,  and  the  cause  of  the  symptoms  which  led  to 
the  examination  of  the  urine,  not  of  long  standing. 
At  any  rate,  we  meet  with  small  hyaline  casts  in  acute 
Bright's  disease.  But  what  does  a  large  hyaline  cast 
signify  ?  It  tells  the  story  of  a  more  advanced  dis- 
ease, and  its  transparency  is  not  due  to  a  refusal  of 
the  epithelium  to  come  FIG.  11. 

off  with  it,  and  thereby 
asserting  its  healthiness ; 
but,  on  the  contrary,  its 
very  size  bears  evidence 
of  the  previous  shed- 
ding of  the  epithelium, 
and  of  the  present  nudity 
of  the  tubule  whence  it 
came. 

A  cast  of  this  last  va- 
riety   may    be     perfectly     «>  Hyaline  casts  ;  b,  Epithelium  casts. 

transparent,  or   it    may  be  dotted  over  with  a  few 
specks  of  granular  matter,  and  perhaps  here  and  there 
a  broken-down  epithelium  cell. 
3 


50  ANALYSIS     OF     THE     URINE. 

It  is  evident  that  in  chronic  disease  of  the  kidney, 
both  small  and  large  hyaline  casts  will  be  found  in  the 
urine,  because  the  organ  is  not  equally  diseased  in  all 
its  parts.  (Fig.  11,  a.) 

Epithelium  Casts.— We  have  seen  that  the  effu- 
sion of  n'brinous  material  into  the  uriniferous  tnbules 
undergoes  spontaneous  coagulation,  and  is  afterward 
washed  out  by  the  urine  which  collects  behind  it;  and 
that  if  the  epithelium  lining  the  tubules  be  detached 
or  detachable,  it  will  adhere  to  the  mould,  and  be 
afterward  found  in  that  situation  in  the  urine. 

The  cells  may  be  scattered  upon  the  surface  of  the 
cast  or  may  present  a  regular  arrangement,  the  same 
which  existed  while  they  yet  occupied  their  normal 
place  in  the  kidney.  At  the  same  time,  there  will  be 
found  free  epithelium  in  the  urine. 

Epithelium  casts  are  found  in  the  urine  of  persons 
convalescing  from  scarlet  fever,  and  in  acute  Bright's 
disease.  In  pneumonia  and  severe  inflammatory  dis- 
eases, they  are  the  prevailing  variety  of  cast.  (Fig.  11,  &.) 

Fatty  Casts  are  epithelium  casts  in  which  the 
epithelium  has  undergone  a  fatty  degeneration.  The 
cells  appear  to  have  been  filled  with  fat  and  to  have 
burst,  discharging  their  oily  contents  into  the  tubules, 
where  they  have  adhered  to  the  h'brinons  effusion. 
The  cast  will  be  more  or  less  covered  with  these 
minute  oil-drops  and  epithelial  cells,  which  are  also 
full  of  oil  or  fat.  At  the  same  time,  fatty  cells  and 
free  fat  will  be  seen  floating  in  the  urine.  (Fig.  12,  a.) 

Casts  of  this  description  are  found  in  chronic  affec- 
tions of  the  kidney,  and  their  presence  in  the  urine  is 
a  very  grave  sign. 


ANALYSIS    OF    THE    URINE.  51 

Granular  Casts  represent  the  epithelial  element 
in  a  state  of  granular  degeneration.  What  this  granu- 
lar material  is,  is  not  very  well  understood,  though 
supposed  to  be  fat  in  a  state  of  fine  subdivision.  The 
cell  may  have  entirety  disappeared,  or  may  remain, 
filled  with  these  granules.  These  casts,  appearing  in 
abundance,  are  indicative  of  serious  changes  in  the 
kidneys,  and  their  presence  determines  an  unfavorable 
prognosis.  Fig.  12,  b,  no.  12. 

illustrates  the  granular 
cast.  It  will  be  noticed 
that  they  are  dark,  and 
have  ragged  extremities. 

Blood    Casts.  —  If 
there  is  a  hemorrhage  in. 
the     kidney    when     the 
conditions    are     present 
which    induce    the    for- 
mation    of     casts,     the 
blood-globules  will  attach       «>  Fa»y casts  ? 6- Granular  casts- 
themselves  to  the  mould,  sometimes  very  regularly, 
and  form  what  is  called  a  blood  cast.     At  the  same 
time,  they  will  be  present  in  a  free  state  in  the  urine. 

Blood  casts  are  common  in  scarlet  fever  and  any 
form  of  acute  Bright's  disease.  They  do  not  gen- 
erally present  themselves  for  any  length  of  time, 
being  the  result  of  a  hemorrhage  which  is  not  apt  to 
continue. 

Pus  Casts. — These  are  rare.  They  are  met  with 
where  the  kidney  is  the  seat  of  abscess.  Yet  cases 
where  abscess  was  found  at  post-mortem  examina- 
tions, and  furnished  no  pus  casts  during  life,  are  re- 


52  ANALYSIS     OF    THE     URINE. 

corded.  When  present,  they  have  the  appearance  of 
pus  corpuscles  adhering  to  the  fibrinous  cast.  The 
urine  will  at  the  same  time  contain  more  or  less  pure 
pus.  To  prevent  confounding  pus  corpuscles  and 
epithelium,  it  is  well  to  note  that  they  are  smaller, 
and  the  addition  of  acetic  acid  will  render  the  cell- 
wall  of  the  pus  corpuscle  transparent,  and  reveal  a 
distinct  granular  nucleus. 

Amyloid  or  Waxy  Casts  are  the  large,  transpa- 
rent, and  waxy-looking  objects  which  are  occasionally 
seen,  and  are  thought  by  some  to  denote  a  correspond- 
ing condition  of  the  kidney.  But  nothing  definite  is 
yet  known  concerning  them.  They  sometimes  present 
a  few  transverse  markings  and  fissures,  as  though  they 
were  very  brittle  and  had  been  broken. 

This  completes  the  list  of  casts,  and  it  may  be  use- 
ful to  sum  up  their  clinical  significance. 

The  appearance  of  a  few  small  hyaline  casts  may 
be,  and  probably  is,  the  result  of  a  congestion  in  the 
kidney  of  recent  origin. 

Epithelial  and  hyaline  casts  are  very  frequently 
found  in  the  urine  of  patients  recovering  from  scarlet 
fever,  pneumonia,  bronchitis,  and  congestive  diseases 
generally. 

Fatty,  granular,  and  waxy  casts  have  a  grave  signif- 
icance ;  yet  the  appearance  of 'one  or  two  of  them 
should  not  induce  us  to  pronounce  too  certainly  the 
fatal  termination  of  the  case. 

It  is  the  continuance  of  a  prevailing  kind  of  cast 
which  is  most  to  l>e  relied  upon  in  the  way  of  diagno- 
sis and  prognosis. 

DETECTION. — We  depend  upon  the  microscope  al- 


ANALYSIS     OF     THE     URINE. 


53 


together  for  the  detection  of  casts,  and  considerable 
skill  is  sometimes  necessary  to  distinguish  between 
them  and  certain  extraneous  matters.  The  most  fre- 
quent sources  of  confusion  in  this  respect  are  cotton 
fibres  and  feathers.  Cotton  fibres  are  striated,  and 
are  apt  to  be  folded  or 
twisted.  A  particle  of 
feather  or  hair  has  de- 
finite anatomical  char- 
acters, which  should  be 
too  well  known  to  allow 
of  a  mistake.  The  ap- 
pearances of  these  acci- 
dental substances  are 
shown  in  Figure  10. 
As  a  guide,  it  mav  be 

.  ",  a,   Hairs  ;    b,   Cotton  fibres ;   c.    Starch 

Said    Ot    CastS,    that    thej       grains ;  d,  Air-bubbles ;  «,  Feathers. 

are  generally  rounded  at  one  extremity,  have  parallel 
sides,  and  are  not  flexible  enough  to  allow  of  folding 
or  twisting. 

Casts  are  liable  to  disintegrate,  and  may  become  so 
changed  as  to  escape  detection  if  allowed  to  remain 
in  decomposing  urine.  Therefore  it  is  important  to 
look  for  them  before  decomposition  begins.  The 
lightest  cast  will  have  fallen  to  the  bottom  of  the 
urine-glass  in  ten  or  twelve  hours.  Then  gently  pour 
away  all  the  urine  except  about  two  drachms,  and  from 
this,  with  the  aid  of  a  glass  tube,  take  up,  from  the 
bottom,  a  drop  or  two  for  microscopic  examination. 
(See  last  page  for  detailed  directions  for  microscopic 
manipulations.) 

Pus. — The're  are  various  causes  giving  rise  to  pus 


54  ANALYSIS    OF    THE    URINE. 

in  the  urine.  Cystitis,  pyelitis,  gonorrhoea — in  fact,  an 
abscess  or  ulceration  communicating  with  the  urinary 
tract  at  any  point.  In  women,  purulent  discharges 
from  the  vagina  are  likely  to  confuse  us  as  to  the  ori- 
gin of  the  pus  found  in  their  urine. 

Urine  containing  pus  is  turbid  when  voided,  and,  on 
standing,  deposits  a  whitish  cloud  of  a  ropy  consisten- 
cy, which  distinguishes  it  from  an  inorganic  deposit. 
It  decomposes  very  readily  and  emits  a  nauseous  odor. 
TESTS. — Pus  consists  of  a  fluid  and  a  corpuscular 
element.  The  fluid  is  albuminous,  and  will  be  acted 
on  accordingly  by  heat  and  nitric  acid,  although  puru- 
lent urine  never  gives  a  marked  coagulum;  and  this 
fact  serves  as  a  good  test,  the  turbidity  not  disappear- 
ing with  heat  and  nitric  acid,  and  at  the  same  time 
scarcely  becoming  more  marked. 

Liquor  potassa  causes  a  semi-solid,  gelatinous  pre- 
cipitate. 

The  microscope  will  reveal  the  pus  corpuscles,  and 
FlG-13-  this    is    conclusive    evi- 

dence. These  bodies  are 
a  little  larger  than  the 
blood  corpuscles,  color- 
less and  spheroidal. 
They  are  made  up  of 
cell-wall,  granular  con- 
tents, and  nuclei.  By  the 
addition  of  a  drop  of 
acetic  acid,  the  cell-wall 
is  rendered  t  r  a  n  s  p  a- 

a,  Pus  corpuscles ;   b,  Effect  of   acetic  ,    ,  ••  •. 

acid'  rent,  and  the  nucleus  is 

brought  sharply  into  view.     (Fig.  13.) 


ALALYSIS    OF    THE     URINE.  55 

Oil. — It  has  been  asserted  that  oil  is  a  constituent 
of  normal  urine  in  very  small  proportion,  and  only 
detected  after  a  careful  analysis.  It,  however,  sometimes 
makes  its  appearance  in  quantities  sufficient  not  only 
to  be  recognized  under  the  microscope,  but  visible  to 
the  unassisted  eye. 

It  may  present  itself  either  as  distinct  oil-drops,  as 
granules,  or  as  a  very  fine  emulsion,  each  particle  of 
which  appears  as  a  mere  point  under  the  microscope 
(this  latter  condition  we  have  in  chylous  urine).  If 
either  of  these  forms  of  fat  are  in  the  urine,  we  shall 
have  a  layer  of  it  on  the  surface  when  allowed  to  rest. 
In  the  case  of  granular  fat,  the  layer  will  appear 
creamy ;  where  the  globules  are  of  any  size,  a  yellow, 
oily  layer  will  be  seen. 

Oil  globules  \vere  detected  in  the  urine  of  a  man 
who  was  taking  cod-liver  oil  by  Roberts.  Fatty  de- 
generation of  the  kidneys  is  accompanied  by  oil  in 
the  urine.  Much  speculation  has  been  indulged  in 
concerning  the  source  of  oil  where  there  is  no  recog- 
nizable affection  of  any  organ.  It  is  known  that 
during  digestion,  the  blood  is  loaded  with  chyle,  and 
may,  under  circumstances  not  understood,  permit  it  to 
escape  into  the  urine.  (See  "  Chylous  Urine.") 

A  frequent  source  of  oil-drops  in  the  urine  is  the 
vessel  in  which  it  is  collected,  or  the  bottle  in  which 
it  is  brought  to  the  physician,  and,  in  many  instances, 
the  passage  of  catheters  and  sounds,  which  are  always 
oiled  before  being  introduced. 

TESTS. — Oil  is  soluble  in  ether.  But  if  it  be  in 
small  quantity,  it  often  becomes  necessary  to  first 


56  ANALYSIS    Ofr    THE    URINE. 

extract  it  with  ether,  and  afterward  evaporate  almost 
to  dryness  before  any  traces  of  it  can  be  seen. 

Under  the  microscope,  oil-drops  are  distinguished 
by  their  perfectly  circular  outline,  difference  in  size, 
and  solubility  in  ether.  As  seen  in  urine,  the  glo- 
bules are  never  very  large,  and  might  be  mistaken  for 
blood  corpuscles.  But  their  sharp-cut,  bright  outline, 
absence  of  color,  and  peculiar  properties  mentioned 
above,  can  scarcely  fail  to  identify  them. 

Chylous  Urine. — Chylous  urine  has  ever  been 
one  of  the  most  interesting,  and  at  the  same  time  puz- 
zling conditions  with  which  we  have  to  deal.  In  appear- 
ance, it  is  milky,  and  on  standing  collects  in  a  creamy 
layer  on  the  surface.  There  is  always  more  or  less 
blood,  fibrine,  and  albumen  present.  Sometimes  it 
coagulates  spontaneously  when  passed,  and  very  closely 
resembles  blanc  mange.  Cases  are  related  where  it 
coagulated  in  the  bladder  and  complete^  blocked  up 
the  urethra,  from  which  it  was  extracted  in  long  flakes. 
It  is  a  rare  affection,  and  but  few  cases  are  reported. 
"Writers  disagree  widely  concerning  its  pathology  and 
symptoms;  but  without  going  over  the  history  at 
length,  the  following  are  the  "main  points  regarding 
this  peculiar  disease : 

It  is  most  common  in  warm  climates;  makes  its 
appearance  suddenly,  and  as  suddenly  ceases,  to  re- 
appear again  after  \ionths  or  even  years.  Sometimes 
it  coagulates  spontaneously,  like  lymph,  and  again 
does  not  undergo  this  change.  The  rnilkiness  is  more 
marked  after  meals.  The  older  authors  considered 
the  kidneys  and  the  assimilative  functions  -of  the 
system  to  be  at  fault  and  diseased.  But  casts  have 


ANALYSIS     OF    THE     URINE.  57 

been  searched  for  in  vain,  and  several  post-mortem 
examinations  of  individuals  who  were  affected  with 
this  disease  have  failed  to  afford  evidence  of  altera- 
tions in  any  organ.  So  that  now  it  begins  to  be 
stated  that  the  chyle  and  lymph  are  discharged  directly 
into  the  urinary  passage  from  the  lymphatic  vessels 
themselves ;  and  Hoberts  especially  advances  this 
opinion,  having  noticed,  in  patients  voiding  chylous 
urine,  appearances  which  indicated  disease  of  the 
lymphatics. 

We  had  an  opportunity  recently  of  examining  a 
specimen  of  chylous  urine,  the  history  of  which  it 
may  be  well  to  relate.  The  patient  had  resided  in 
the  South  most  of  his  life.  About  ten  weeks  before, 
he  had  attempted  to  pass  his  urine  five  times  within 
an  hour.  This  necessitated  great  straining,  and  he 
was  suddenly  alarmed  by  a  severe  pain  and  a  discharge 
of  blood  and  milky  urine.  (The  pain  was  located  in 
the  prostatic  urethra,  and  as  he  had  undergone  an  op- 
eration for  stone  a  few  years  before,  it  and  the  hem- 
orrhage were  referred  to  that  cause.)  This  condition 
came  and  disappeared  several  times  until  we  saw  the 
urine.  The  patient  stated  that  the  milky  fluid  some- 
times was  perfectly  free  from  any  urine.  He  was  able 
to  know  this  from  the  fact  that  the  uriniferous  odor 
was  entirely  absent,  and,  moreover,  the  bladder  had 
just  been  emptied  only  a  few  minutes  before. 

This  urine  did  not  coagulate  spontaneously.  It 
contained  blood,  and  had  an  alkaline  reaction. 

TESTS. — Besides  the  characters  above  stated,  other 
tests  are  scarcely  necessary.  Chyle  is  oil  in  a  state  of 
emulsion. 

3* 


58 


ANALYSIS    OF    THE    URINE. 


Under  the  microscope,  the  granules  appear  very 
minute. 

Spermatozoa. — The  spermatic  elements  some- 
times become  mingled  with  the  urine  in  sufficient 
numbers  to  form  a  deposit.  As  a  deposit,  they  re- 
semble mucus  and  pus,  though  never  so  abundant. 
Their  presence  may  be  accounted  for  as  a  result  of 
coition  or  an  involuntary  discharge  of  semen.  This 
latter  may  be  continuous  and  constitute  spermator- 
rhoea. With  the  exception  of  this  last-named  condi- 
tion, the  presence  of  spermatozoa  in  the  urine  is 
without  significance. 

TESTS. — The  semen  is  albuminous,  and  will  be  ren- 
dered cloudy,  to  a  more  or  less  degree,  by  heat  and 
nitric  acid.  But  the  microscope  will  decide  whether 
the  albuminous  reaction  is  due  to  the  presence  of 
semen,  in  that  it  will  reveal  the  characteristic  fila- 
ments or  spermatozoa.  If  the  specimen  be  recent,  they 
will  be  in  active  motion.  Spermatozoa  are  possessed 
of  a  head  and  tail-like  extremity,  the  former  being 
slightly  flattened  from 
before  backward.  Their 
length  is  about  ^  of 
an  inch.  Fig.  14,  a.} 

Cystine. — This  is  a 
substance  but  rarely  met 
with,  compared  with 
other  deposits.  Its 
source  is  not  positively 
known,  though  supposed 

a,  Spermatozoa;  b,  Bacteria.  to    be    the   liver.       Are- 

markable  fact  concerning  it  is  its  liability  to  run  in 


ANALYSIS.   OF     THE     U II  INK. 


families.  The  most  important  clinical  significance 
attaching  to  it  is  its  liability  to  form  a  calculus  ;  other 
wise  eystine  may  appear  in  the  urine  of  an  indi- 
vidual for  years  and  not  depreciate  the  health. 

Urine  containing  cystine  has  usually  an  oily  ap- 
pearance, and  deposits  a  light,  rose-colored  powder. 
Decomposition  takes  place  very  soon,  and  according 
to  Dr.  Bird,  the  color  changes  to  a  green.  Cystine 
contains  sulphur,  which  in  the  process  of  decomposi- 
tion is  evolved  as  sulphuretted  hydrogen. 

TESTS. — Acetic  acid  will  cause  a  further  precipitate 
to  take  place.  It  is  insoluble  in  the  vegetable  acids, 
and  is  not  dissolved  by  heat.  It  is  soluble  in  am- 
monia and  mineral  acids. 

The  crystals  are  six-sided  plates,  and  colorless.  If 
a  solution  of  cystine  be  placed  in  a  shallow  dish  with 
a  little  ammonia,  evapo-  FIG.  15. 

ration  will  cause  a  de- 
posit of  the  pure  crys- 
tals. Cystine  crystals 
are  easily  distinguished 
from  uric  acid  by  their 
solubility  in  nitric  acid. 
(Fig.  15.) 

Keistine. — It  was  at 
one  time  thought  that 
the  urine  of  pregnant 
women  offered  peculiari- 
ties by  which  the  pregnant  state  could  be  diagnosed. 
It  was  stated  that  there  would  form  upon  the  surface 
of  such  urine  a  layer  of  cheesy  matter  unlike  any  ap- 
pearance presented  when  the  subject  was  not  pregnant. 


Cystine. 


60  ANALYSIS     OF     THE     URINE. 

The  name  keistine  (cheesy)  was  given  to  this  forma- 
tion. The  results  of  observation,  however,  have  been 
so  conflicting  that  the  profession,  to-daj,  do  not  regard 
the  formation  as  a  distinct  one,  but  attribute  the  phe- 
nomenon as  one  and  the  same  thing  as  the  alkaline 
fermentation,  which  is  hastened  in  pregnancy  by  the 
presence  of  an  increased  amount  of  animal  matter,  such 
as  epithelium  and  mucus  from  the  vagina  and  bladder. 

VEGETABLE  FUNGI. 

There  are  several  microscopic  vegetable  growths 
which  invade  the  urine.  The  most  important  are  the 
Penicillium,  glaucum,  or  common  mould,  and  Sac- 
charomyces,  or  sugar  fungus. 

Penicillium  Glau- 
cuxn. — This  is  the  com- 
mon mould  so  frequently 
seen  on  old  leather  and 
articles  kept  in  damp 
places.  It  is  apt  to  ap- 
pear in  urine  when  left 
exposed  at  ordinary  tem- 
perature, but  whether 
there  will  be  a  visible 
deposit  depends  upon 

Pemcillium  Glaucum.  the  extent  of  fche  growth. 

This  fungus  as  seen  under  the  microscope  con- 
sists of  two  distinct  parts:  the  mycelium  and  the 
spores. 

The  mycelium  or  vegetative  portion  is  an  irregular 
interlacement  of  fibres  which  are  immersed  in  the 


ANALYSIS     OF     THE     CRIME.  61 

urine.  From  these  arise  slender  stalks  which  shoot 
upwards  towards  the  surface,  and  on  reaching  it  de- 
velop the  spores  upon  their  extremities. 

It  is  chiefly  by  the  arrangement  of  the  spores  upon 
the  stalk  that  we  are  able  to  distinguish  the  different 
fungi  having  a  mycelium.  In  the  variety  under  con- 
sideration they  are  disposed  in  diverging  rows  and 
have  a  peculiar  whitish-green  color;  hence  its  name. 
(Penicilus,  brush-like,  and  yAawcoc,  sea-green.) 

The  spores  ripen  and  fall  into  the  urine  or  are 
blown  away  to  other  quarters.  In  either  case,  if  the 
locality  be  a  favorable  one,  they  immediately  begin  to 
elongate  and  then  to  branch,  until  very  soon  a  myce- 
lium of  new  growth  is  formed. 

There  are  other  varieties  of  vegetable  fungi  very 
similar  to  penicillium  liable  to  be  encountered  in  a 
microscopic  inspection  of  urine,  but  none  of  them  have 
any  special  interest,  their  presence  being  due  to  the 
ubiquitous  nature  of  their  spores. 

Saccharomyces. — This  is  the  term  applied  to 
the  variety  of  fungus  found  in  solutions  undergoing  the 
vinous  fermentation — conversion  of  sugar  into  alcohol 
and  carbonic  acid.  It  will  make  its  appearance  in  any 
'saccharine  mixture  containing  albuminous  matter  and 
subjected  to  a  temperature  of  about  70°  F.  Saccha- 
romyces is  therefore  especially  interesting  to  the  phy- 
sician in  that  its  appearance  in  urine  is  a  certain  indi- 
cation of  the  presence  of  sugar. 

This  plant  consists  'simply  of  cells  of  about  10 
micro-millimetres  (-g-gV<r  of  an  inch)  in  diameter,  of  an 
oval  or  spheroidal  shape,  generally  colorless  and  hav- 
ing a  granular  appearance,  with  one  or  more  germinal 


62  ANALYSIS     OF     THE     URINE. 

bodies  in  their  interior.  There  are  several  species, 
differing  chiefly  in  the  size  and  shar>e  of  the  cells; 
that  of  beer-yeast  is  known  as  "  Saccharomyces  Cere- 
visiae."  Saccharorayces  multiplies  by  budding,  and 
FIG'.  17.  during  the  active  state 

the  cells  present  appear- 
ances indicative  of  the 
process  ;  from  the  young 
bud  just  beginning  to 
emerge  from  the  parent 
cell,  on  through  the  vari- 
ous stages  of  its  growth 
until  it  has  attained  an 
equal  size,  and  finally 
separates.  Occasionally 

Saccharomyces  cerivisi*.  the    new    ceU    putg     forth 

buds  before  it  becomes  independent  and  gives  rise  in 
this  way  to  a  chain  or  irregular  collection  of  cells,  as 
seen  in  the  figure.1 

Bacteria  (little  rods). — This  is  the  general  term 
given  to  the  minute  vegetable  organisms  invariably 
present  in  putrefying  animal  and  vegetable  matter. 
They  consist  of  simple  cells  filled  with  a  colorless  fluid 
and  presenting  several  varieties  of  form :  spheroidal 
(mierococcus),  curved  (vibrio),  twisted  (spirillum),  and 
oblong,  (bacterium). 

The  varieties  most  common  to  decomposing  urine 
are  bacterium  termo,  vibrio,  and  mierococcus;  but 
unless  we  employ  very  high  powers  of  the  microscope 

1  For  an  elaborate  description  of  these  and  similar  fungi,  see 
Botanische  untersuchungen  iiber  die  Alkoholgarungspilze.  By 
Max.  lleess,  Leipsic.  1870. 


ANALYSIS     OF    THE    TJKINE.  63 

these  last  will  not  be  detected,  on  account  of  their 
very  minute  size. 

Bacterium  termo  measures  about  -^-^  mm.  (y^f^ 
of  an  inch)  in  length  by  about  T^w  mm.  (^-OTT  of  an 
inch)  in  breadth.  Vibriones  are  of  about  the  same 
width,  but  three  or  four  times  longer. 

The  most  remarkable  feature  connected  with  these 
bodies  is  their  active  motion,  which  is  seen  to  consist 
of  rapid  vibrations  with  the  effect  to  propel  the  cell 
with  considerable  velocity  through  the  fluid. 

The  appearances  presented  by  bacteria  of  two  cells 
connected  together  is  due  to  their  mode  of  multiplica- 
tion being  by  division ;  if  closely  watched  the  sepa- 
ration will  very  soon  be  seen  to  be  complete. 


PART  IY. 

ACCIDENTAL   INGREDIENTS   WHICH   DO   NOT   FORM 
DEPOSITS. 

THERE  are  certain  abnormal  substances  frequently 
present  in  urine,  but  which  are  in  such  perfect  solu- 
tion as  to  afford  no  evidence  of  their  presence  by 
way  of  a  deposit,  and  with  the  exception  of  bile  may 
have  little  or  no  effect  upon  the  natural  color. 

Such  are  albumen,  sugar,  and  bile. 

Albuminuria. — We  have  seen  that  urine  con- 
taining pus,  blood,  or  semen  will  necessarily  be  albu- 
minous, but  we  come  now  to  consider  albuminuria 
which  is  not  due  to  the  presence  of  either  of  the  above 
but  which  is  occasioned  by  the  escape  of  the  albumin- 
ous constituents  of  the  blood  through  the  kidneys. 
This  phenomenon  may  result  from 

1.  Mai-assimilation  of  albuminous  food. 

2.  Mechanical  obstruction  to  the  renal  circulation. 

3.  Chronic  degeneration  of  the  kidneys. 

We  know  that  in  order  to  be  assimilated  albumin- 
ous substances  must  first  be  converted  into  alburnin- 
ose,  and  subsequently  into  blood-albumen.  Now  it  is 
a  well  established  fact  that  if  this  process  is  not  carried 
out  and  albumen  enters  the  circulation  imperfectly 
digested,  it  is  immediately  eliminated  by  the  kidneys. 
It  is  therefore  easy  to  understand  how  deranged  diges- 


ALALYSIS     OF    THE     URINE.  f>5 

tion  or  excessive  indulgence  in  albuminous  food  will 
be  sometimes  followed  by  albuminuria. 

Mechanical  obstruction  will  include  all  of  those 
conditions  which  interfere  with  the  normal  circulation 
of  the  kidneys  and  induce  congestion.  The  cause  may 
be  an  inflammation  of  the  kidney  itself  as  in  nephritis 
(Bright' s  disease) ;  it  may  be  due  to  passive  congestion 
from  hepatic  or  cardiac  disease  or  the  pressure  of  a  tu- 
mor, and  it  is  induced  by  the  specific  poisons  of  many 
general  affections,  as  rheumatism,  gout,  scarlet,  yellow, 
typhus  and  typhoid  fevers,  and  malaria.  Increased 
blood-pressure  is  also  brought  about  in  the  kidneys  by 
lesions  of  the  central  nervous  system.  In  these  the 
vaso-motor  filaments  are  paralyzed. 

Chronic  degenerations  of  the  kidneys  are,  as  a  rule, 
the  result  of  prolonged  congestions  ;  and  the  albumen 
which  escapes  them  is  principally  due  to  a  continuance 
of  this  condition  and  the  frequent  attacks  of  inflamma- 
tion to  which  they  are  especially  liable. 

Albuminous  urine  has  certain  characteristics  appre- 
ciable by  simple  ocular  inspection.  In  the  first  place 
it  froths  more  ihan  normal  urine,  when  violently  agi- 
tated ;  and  if  the  disease  be  of  long  standing  the  color 
will  be  light  and  the  specimen  present  a  peculiar  hazy 
appearance  due  to  the  presence  of  casts,  fat  granules 
and  epithelium.  In  nephritis  there  will  be  more  or 
less  blood  present. 

The  specific  gravity  of  albuminous  urine  is  low — 
1004-1015 — on  account  of  the  deficiency  in  solids, 
especially  urea. 

It  is  of  the  highest  importance  to  subject  urine  in 
which  albumen  has  been  detected,  to  a  microscopic  ex- 


66  ANALYSIS    OF    THE    URINE. 

amination ;  for  it  is  by  the  presence  or  absence  of  casts 
and  certain  other  debris  that  we  are  able  to  judge  of 
the  morbid  conditions  which  prevail.  (See  "Casts.") 

Albumen  always  exists  in  urine  where  casts  are 
found,  but  casts  are  not  necessarily  present  in  every 
instance  with  albumen. 

TESTS. — Albumen  is  coagulated  by  heat,  alcohol, 
the  mineral  acids  and  by  a  solution  of  acetic  acid  and 
potassium  ferrocyanide.  Other  methods  do  not  con- 
cern us. 

A  test-tube  is  one-third  filled  with  the  suspected 
urine,  and  held  in  the  flame  of  a  spirit-lamp  until  boil- 
ing is  fairly  going  on.  If  any  perceptible  opacity  has 
ensued  it  can  be  due  to  two  things — albumen  or  the 
earthy  phosphates.  The  question  is  determined  by 
the  addition  of  one  or  two  drops  of  nitric  acid ;  if  it 
be  albumen  the  opacity  is  slightly  increased,  if  the 
phosphates  it  entirely  disappears. 

When  the  amount  of  albumen  present  is  very 
small  it  is  necessary  to  proceed  very  carefully  and 
have  an  equal  quantity  of  the  same  specimen,  which 
has  not  been  manipulated,  in  another  test-tube  for 
comparison.  Nitric  acid  alone  is  a  delicate  test  for 
albumen.  The  test-tube  should  be  inclined  and  the 
acid  allowed  to  run  down  the  side  and  gain  the  bottom, 
where  it  will  be  seen  as  a  clear  layer.  If  albumen  be 
present  there  will  appear  an  opaque  stratum  where  the 
urine  and  acid  come  in  contact. 

There  are  two  fallacious  results  which  are  likely  to 
follow  the  addition  of  nitric  acid  to  urine  containing 
an  excess  of  either  urea  or  the  urates,  which  might 
mislead  a  novice.  With  the  first  there  rnav  be  a  crvs- 


ANALYSIS     OF     THE     URINE.  67 

talline  precipitate  of  nrea  nitrate;  with  the  second 
an  amorphous  deposit  of  uric  acid.  Neither  of  these, 
however,  should  be  taken  for  albumen,  for  they  both 
disappear  when  heated ;  and  besides  the  urea  salt  pre- 
sents definite  crystals  as  will  the  uric  acid  if  allowed 
to  stand  a  few  hours. 

The  most  delicate  test  for  albumen  is  with  acetic 
acid  and  potassium  ferroeyanide.  Render  the  fluid  to 
be  tested  distinctly  acid  with  acetic  acid  and  add  a 
few  drops  of  a  solution  of  potassium  ferrocyanide;  the 
presence  of  albumen  will  be  indicated  by  an  increased 
opacity. 

There  is  one  fact  to  be  borne  in  mind  in  testing 
with  heat  alone  where  no  evident  effect  follows  its  ap- 
plication. It  is  that  a  strongly  alkaline  condition  will 
hold  albumen  in  solution  against  heat ;  hence  the  im- 
portance of  always  employing  nitric  acid  after  boiling. 

A  convenient,  and  for  general  purposes  a  sufficiently 
accurate,  method  for  estimating  the  quantity  of  albu- 
men from  day  to  day,  is  simply  to  coagulate  with  heat 
and  nitric  acid  and  allow  the  coagulum  to  collect  at 
the  bottom  of  the  test-tube  and  compare  its  mass  with 
the  amount  of  urine  used,  as  J,  •£,  etc.  For  greater 
accuracy  a  graduated  tube  may  be  used. 

Sugar. — There  is  a  grave  disorder  chiefly  charac- 
terized by  the  excretion  of  enormous  quantities  of 
saccharine  urine  of  high  specific  gravity,  1030-1060, 
known  as  diabetes  mellitus.  The  pathology  is  obscure. 
"We  know  that  one  of  the  functions  of  the  liver  is  to 
produce  sugar,  and  that  this  process  is  carried  on  in- 
dependent of  saccharine  and  starchy  food.  But  what 
is  the  particular  lesion  or  class  of  lesions  which  causes 


68  ANALYSIS    OF    THE    URINE. 

the  fluids  of  the  body  to  be  saturated  with  sugar  is 
not  determined. 

It  has  been  suggested  that  diabetes  mellitus  may 
be  due  to  two  distinct  conditions  : — An  excessive  pro- 
duction of  sugar  by  the  liver,  and  a  failure  of  the  sys- 
tem to  assimilate  that  normally  produced. 

Experimentally  sugar  can  be  made  to  appear  in  the 
urine  by  various  operations  upon  the  nervous  system  and 
by  any  means  which  accelerates  the  portal  circulation. 

The  ingestion  of  large  quantities  of  sugar  or  food 
containing  it,  especially  after  fasting,  will  induce  a 
saccharine  condition  of  the  urine.  Disease  of  the 
liver  is  not,  then,  necessarily  the  primary  cause  of 
diabetes. 

Sugar  appears  in  the  urine,  temporarily,  during 
the  course  of  various  affections,  as, — disease  and  injury 
of  the  nervous  system,  mental  shock,  amputation, 
pregnancj7,  etc. 

Saccharine  urine  presents  a  peculiar  bright  straw 
color.  Albumen  is  frequently  present.  A  drop  pluced 
upon  the  fingers  and  allowed  to  evaporate  leaves  a 
sticky  molasses-like  residue. 

TESTS. — If  saccharine  urine  be  boiled  with  liquor 
potassse,  it  will  assume  a  dark  brown  or  molasses  color. 
This  is  known  as  Moore's  Test.  It  is  unreliable  in 
that  any  urine  of  high  specific  gravity  will  give  the 
same  result. 

If  a  little  yeast  be  added  to  urine  containing  sugar, 
fermentation  will  ensue,  whereby  carbonic  acid  gas 
and  alcohol  are  produced.  The  gas  escaping  in  bub- 
bles can  be  collected  and  tested.  This  is  a  good  test, 
but  not  a  very  convenient  one.  It  is  not  necessary  to 


ANALYSIS     OF     THE     UKINK.  OU 

add  yeast  except  to  hasten  the  result,  for  if  sugar  is 
present  in  urine  the  yeast  fungus,  saccharomyces  cere- 
visice,  will  be  spontaneously  developed  and  the  decom- 
position proceed  as  in  the  former  case.  A  convenient 
apparatus  with  which  to  apply  the  fermentation  test  to 
urine  is  constructed  as  follows :  Procure  a  glass  jar  or 
test-tube  capable  of  standing  upright,  and  provide  it 
with  a  tight-fitting  stopper.  Through  the  stopper  let 
a  glass  tube  descend  almost  to  the  bottom  of  the  jar. 
Half  an  inch  of  the  lower  extremity  of  this  tube 
should  be  bent  upwards,  and  that  portion  which  is 
outside  the  jar  curved  so  as  to  have  its  extremity  di- 
rected downwards.  Fill  the  jar  with  the  suspected 
urine,  add  a  small  lump  of  German  yeast,  and  adjust 
the  cork  and  tube.  The  whole  is  now  to  be  kept  in  a 
moderately  warm  place,  70°  F.,  for  about  48  hours; 
and  if  sugar  be  present,  except  in  very  minute  amount, 
the  decomposition  into  alcohol  and  carbonic  acid  gas 
will  take  place.  The  gas  accumulating  at  the  top  of 
the  jar  and  unable  to  escape,  presses  upon  the  urine 
below,  and  drives  it  out  of  the  long  glass  tube.  Hav- 
ing collected  a  quantity  of  gas,  the  cork  is  carefully 
removed  and  the  usual  tests  for  carbonic  acid  applied. 

Trammer's  Test. — This  method  of  determining 
the  presence  of  sugar  in  a  solution  is  based  upon  the 
fact  that  sugar  possesses  the  property  of  immediately 
reducing  the  salts  of  copper  in  an  alkaline  solution  at 
the  boiling-point. 

The  usual  mode  of  applying  this  test  is  to  add  two 
or  three  drops  of  a  solution  of  copper  sulphate  to  a 
quantity  of  the  suspected  fluid  in  a  test-tube,  and  then 
pour  in  an  excess  of  liquor  potassic.  If  sugar  be  pros- 


70  ANALYSIS     OF    THE    UKINE. 

ent,  the  whole  now  assumes  a  deep,  transparent  blue 
color.1  Upon  boiling,  copper  oxide  will  be  thrown 
down  as  a  bright  yellow  precipitate  (in  some  cases  an 
orange  red).  When  this  change  occurs,  the  blue  color 
disappears  entirely,  and  the  mixture  becomes  perfectly 
opaque. 

Unfortunately  when  applied  to  the  urine  after  the 
above  manner,  these  phenomena  do  not  present  them- 
selves. Having  added  the  copper  and  potassa.  there 
will  appear  the  usual  transparent  blue  color,  but  when 
boiled  we  almost  invariably  fail  to  see  anything  like  a 
yellow  or  red  precipitate.  Either  the  blue  color  is 
entirely  destroyed,  and  a  dark,  transparent,  molasses 
color  appears,  .or  there  is  a  dirty  green  precipitate. 

Considerable  has  been  written  concerning  the  in- 
applicability of  Trommer's  test  to  the  urine,  the  expla- 
nation being  that  the  organic  constituents,  urea,  color- 
ing matter,  etc.,  interfere  with  the  reduction  of  the 
suboxide  of  copper.  Directions  have  therefore  been 
given  to  get  rid  of  these  matters  by  filtration  through 
finely-powdered  animal  charcoal.  This  process  is  an 
efficient,  but  as  a  general  rule,  not  a  convenient  one 
for  the  practicing  physician. 

1  If  a  solution  of  copper  sulphate  be  treated  with  potassium 
hydrate  there  will  be  a  pale  blue  precipitate  of  copper  hydrate 
formed  ;  but  if  we  add  a  small  quantity  of  tartaric  acid  previous 
to  the  potassium  the  precipitate  will  be  redissolved  on  the  addi- 
tion of  an  excess  of  the  latter. 

Sugar  has  a  property  similar  to  tartaric  acid  in  this  respect, 
and  the  very  fact  that  on  the  addition  of  the  reagents  of  Trom- 
mer's test  to  a  fluid  results  in  the  production  of  a  perfectly  clear 
blue  color,  is  in  favor  of  the  presence  of  sugar.  We  should  never 
be  satisfied  however  with  this  evidence  alone,  especially  in  deal- 
ing with  the  urine. 


ANALYSIS     OF    THE     URINE.  71 

Therefore,  because  I  believe  this  method  to  be  the 
most  simple  and  reliable  one,  I  submit  the  follow- 
ing hints  and  rules  for  the  application  of  Trommer's 
test  to  the  urine ;  they  being  the  result  of  a  series  of 
investigations  on  the  subject.1 

In  the  first  place,  it  is  necessary  to  have  a  great 
excess  of  the  test,  because  if  the  urine  be  in  too  great 
quantity,  the  precipitate  is  dissolved  ;  and  on  this  fact 
depends  my  method. 

Proceed  as  follows :  Place  about  4  c.c.  (1  3  .)  of  the 
urine  in  a  test-tube,  and  to  it  add  about  4  drops  of  a 
copper  sulphate  solution  made  in  the  proportion  of  1 
part  of  copper  sulphate  to  8  parts  of  water.  To  this 
mixture  add  liquor  potasses  until  the  milky  precipitate 
first  formed  is  dissolved  and  the  whole  assumes  a  per- 
fectly transparent  blue  color. 

The  conditions  now  are  such  that  the  precipitate  of 
copper  oxide  will  be  in  such  amount  as  not  to  be  to- 
tally dissolved  by  the  small  quantity  of  urine  employed. 
Therefore  when  this  blue  mixture  is  boiled  the  reaction 
is  as  satisfactory  as  with  a  watery  solution  of  sugar. 
If  there  is  no  immediate  reaction  set  the  test-tube 
aside  and  wait  ten  or  twenty  minutes.  There  is  no 
change  if  the  urine  is  free  from  sugar. 

If  albumen  is  present  the  color  resulting  from  the 
mixture  of  the  test  fluids  will  assume  a  purplish  hue, 
and  may  interfere  with  the  process.  It  can  be  removed 
by  coagulating  and  filtering. 

Do  not  mistake  the  flocculi  of  the  phosphates, 
thrown  down  by  the  alkaline  test  fluid,  for  a  precipi- 
tate of  the  suboxide  of  copper.  This  latter  is  dark 
1  New  York  Medical  Journal.  June,  1874,  p.  632. 


72  ANALYSIS     OF     THE     URINE. 

red  or  yellow,  and  soon  subsides  to  the  bottom  of 
the  test-tube,  and  is  seen  there  as  a  compact  little 
mass. 

The  test  with  FEHLING'S  SOLUTION  (for  composition, 
see  p.  75)  is  based  upon  the  same  principle  ns  the 
foregoing,  and  if  we  have  the  solution,  it  is  a  very 
easy  and  reliable  test.  But  it  has  to  be  prepared,  and 
when  kept  for  any  length  of  time,  is  liable  to  undergo 
changes  which  unfit  it  for  further  use. 

The  way  to  use  it  is  to  take  a  test-tube  a  quarter 
full  and  boil  it.  To  this  add  a  drop  of  the  suspected 
urine  if  much  sugar  is  present;  if  little,  add  ten  or 
fifteen  drops. 

Here  we  have  the  same  principle  as  advised  with 
Trommer's  test — namely,  a  small  quantity  of  urine 
and  a  great  excess  of  the  test  fluid. 

If  any  change  occurs  in  the  Fehling  liquor  when 
boiled  alone,  it  is  unfit  for  use. 

Bile. — The  coloring  matter  of  the  bile  is  frequently 
excreted  with  the  urine,  imparting  to  it  a  more  or  less 
greenish-brown  color. 

It  occurs  in  jaundice  even  before  the  skin  has  be- 
come perceptibly  colored,  and  continues  a  little  while 
after  the  natural  color  is  restored. 

The  biliary  salts,  glykocholate  and  taurocholate  of 
soda,  sometimes  are  present  also,  and  it  is  frequently 
important  to  know  whether  the  bile  is  represented  in 
the  urine  solely  by  its  coloring  matter,  or  whether 
these  more  important  ingredients  are  there  too. 

TESTS. — The  coloring  matter  of  bile  can  be  detected 
by  pouring  a  little  of  the  urine  into  a  white  plate, 
and  allowing  it  to  come  in  contact  with  a  few  drops 


ANALYSIS    OF    THE    UKIXE.  73 

of  nitric  acid.  As  the  two  mingle,  a  play  of  colors 
will  be  observed,  varying  from  a  violet  to  a  green. 
Any  oxidizing  agent,  tincture  of  iodine,  or  the  atmo- 
sphere, will  produce  a  grass-green  color. 

Instances  may  occur  when  the  bile  pigment  is  present 
in  such  small  amount  as  to  render  its  detection  difficult. 
In  such  cases  the  urine  should  be  allowed  to  remain  at 
rest  several  hours  at  a  low  temperature  to  favor  the 
deposition  of  the  u rates.  If  these  constituents  are 
precipitated  they  will,  appropriate  the  bile  color  and 
by  separating  them  and  dissolving  in  a  small  amount 
of  water  with  heat,  we  can  then  apply  the  nitric  acid 
test  as  above. 

To  detect  the  biliary  salts  we  must  resort  to  "Pet- 
tenkofer's  test"  as  follows :  If  the  color  of  the  urine 
be  very  marked  it  should  be  mixed  with  animal  char- 
coal and  filtered  ;  then  take  about  10  c.c.  (3  ii)  of  the 
clear  liquid  thus  obtained  and  to  it  add  a  few  drops  of 
cane-sugar  (one  part  to  four  of  water).  Sulphuric  acid 
is  now  to  be  added  very  cautiously,  the  test-tube  being 
occasionally  dipped  in  cold  water  to  keep  the  tempera- 
ture thus  developed  at  about  60°.  When  the  acid  is 
first  added  if  the  biliary  salts  are  present  there  will  be 
a  whitish  precipitate  of  cholic  acid,  which  subsequently 
disappears  on  the  continued  addition  of  the  reagent. 
The  next  change  consists  in  a  cherry-red  color  which 
appears  at  the  bottom  of  the  tube.  Cease,  now,  to  add 
the  acid  and  observe  that  the  red  gradually  changes  to 
a  deep  purple. 

It  is  this  play  of  colors  which  constitutes  the  most 
characteristic  feature  of  the  test. 

If  the  urine  contains  albumen  it  should  be  coagu- 
4 


74:  ANALYSIS    OF    THE    URINE. 

lated  and  removed,  as  this  substance  will  imitate  in 
some  degree  the  behavior  of  the  biliary  matters  with 
Pettenkofer's  test. ' 

1  See  Dalton's  Physiology,  1875,  p.  212,  for  other  precautions 
to  be  observed  with  Pettenkofer's  test. 


PAET   V. 

QUANTITATIVE  ANALYSIS. 

SUGAR — UREA. 

SUGAR  and  urea  are  the  only  substances  of  which  it 
is  frequently  of  practical  importance  to  estimate  the 
amount  in  urine. 

Sugar. — There  are  two  methods  by  which  the  phy- 
sician can  readily  determine  the  quantity  of  sugar  in  a 
given  solution  ;  one  necessitating  considerable  skill  in 
chemical  manipulation,  and  the  other  remarkable  for 
its  simplicity. 

The  first  of  these  is  based  upon  the  reactions  with 
Trommer's  test,  the  only  conditions  being  that  we 
must  use  a  graduated  solution,  it  having  been  found 
that  a  certain  amount  of  sugar  will  reduce  a  definite 
quantity  of  copper  sulphate. 

The  solution  commonly  employed  is  known  as 
"  Fehling's  liquor."  This  investigator,  having  dis- 
covered that  5  parts  of  sugar  decompose  34.64  parts 
of  copper  sulphate,  advised  the  following  solution : 

Pure  crystallized  copper  sulphate    .        .       34.64  grammes. 
Neutral  potassium  tartrate        .        .        .     150 
Solution  of  sodium  hydrate  (sp.  gr.    1.12)    650  " 

The  potassium  tartrate  is  dissolved  in  the  solution 


76  ANALYSIS    OF    THE    HEINE. 

of  caustic  soda,  and  the  copper  sulphate  in  a  little  pure 
water.  The  two  solutions  are  now  mixed  and  the 
whole  diluted  with  water  until  the  volume  amounts 
to  1  litre.  10  c.c.  of  this  solution  will  be  decolorized 
,by  .05  grammes  of  sugar.  The  objection  to  Folding's 
solution  thus  prepared  is  its  liability  to  spontaneous 
decomposition  when  kept  for  any  length  of  time,  some 
of  the  copper  being  reduced  by  the  tartaric  acid  which 
is  set  free.  The  following  method  is  therefore  gener- 
ally employed  and  is  much  preferable : 

1st.  Pure  dry  crystallized  copper  sulphate,  34.64 
grammes.  Distilled  water,  1000  grammes.  10  c.c.  of 
this  solution  correspond  to  .05  gramme  of  sugar. 

2d.  Solution  of  potassium  hydrate  (sp.  gr.  about 
1050. 

3d.  A  saturated  solution  of  potassium  bitartrate. 

These  three  solutions  are  to  be  kept  in  separate 
glass-stoppered  bottles,  and  are  not  mixed  until  used. 
They  therefore  do  not  deteriorate  by  keeping.  The 
apparatus  necessary  for  this  analysis  consists  of  a  glass 
chemical  flask  of  250  c.c.  (8  oz.)  capacity ;  burette 
graduated  to  cubic  centimetres  and  tenths ;  spirit  lamp 
and  stand  upon  which  to  place  the  flask  to  boil  its 
contents. 

The  process  is  as  follows:  10  c.c.  of  the  copper  sul- 
phate solution  are  first  put  into  the  flask  and  diluted 
with  about  four  times  as  much  water.  About  10  c.c. 
of  the  potassium  tartrate  solution  are  now  added  and 
well  mixed,  after  which  pour  in  the  solution  of  potas- 
sium hydrate  until  the  whole  assumes  a  clear  blue  color. 


ALALYSIS     OF    THE     URINE.  77 

Our  test-fluid  is  now  ready.  Set  it  to  boil.  Then  take 
2  c.c.  of  urine  and  dilute  it  with  18  c.e.  of  water ; '  the 
mixture  now  consists  of  TV  urine.  By  this  time  ebul- 
lition has  commenced  in  the  flask  and  we  proceed  to 
add,  drop  by  drop,  the  mixture  of  urine  and  water 
and  closely  watch  the  result.  As  the  saccharine  urine 
comes  in  contact  with  the  boiling  copper  solution  some 
of  the  latter  is  decomposed  and  appears  as  a  red  pre- 
cipitate. A  time  will  at  length  arrive  when  the  whole 
mixture  changes  to  a  brick-dust  red,  and  no  blue  color 
remains.  The  entire  operation  should  cease  every  little 
while  to  allow  the  red  copper  oxide  to  settle,  when  it 
will  be  easy  to  determine  whether  any  blue  color 
remains  in  the  supernatent  liquid. 

During  the  last  part  of  the  process  great  care  is 
necessary  in  order  not  to  add  any  more  urine  after  the 
blue  color  has  disappeared ;  if  we  do  not  stop  at  the 
right  time,  the  mixture  will  suddenly  assume  a  mo- 
lasses color,  the  result  of  the  action  of  the  boiling 
alkali  upon  the  sugar,  and  our  analysis  is  worthless. 
By  a  little  practice  proper  skill  is  readily  acquired. 

Suppose  then  the  blue  color  has  entirely  disappeared 
from  the  mixture  and  we  find  that  30  c.c.  of  the  di- 
luted urine  have  been  used  ;  but  this  only  contains  -jV  or 
2  c.c.  of  urine.  Therefore  2  c.c.  of  the  urine  contain 
.05  gramme  of  sugar.  The  percentage  is  easily  cal- 
culated with  this  system" of  weights  and  measures  : 

2   :    .05  : 1  100   :   x  =  2.5  per  cent. 

Perhaps  the  best  method  to  determine  the  quantity 

1  This  is  in  order  to  add  the  saccharine  urine  more  gradually. 
If  the  sugar  is  not  abundant  this  dilution  is  not  necessary. 


78  ANALYSIS    OF    THE     URINE. 

of  sugar  in  urine,  adapted  to  the  busy  physician,  is  that 
recommended  by  Roberts,1  which  is  based  upon  the  dif- 
ference in  specific  gravity  before  and  after  fermentation. 

The  specific  gravity  of  the  specimen  is  taken  and 
written  down;  a  bottle  provided  with  a  perforated 
cork  is  then  about  half-filled,  and  a  lump  of  German 
yeast  added,  about  the  size  of  a  walnut,  and  the  whole 
placed  where  it  will  remain  at  about  80°  F.  for  eighteen 
hours.  At  the  end  of  this  time  the  decomposition  into 
alcohol  and  carbonic  gas  will  be  complete ;  and  now 
every  degree  of  density  lost  indicates  2.188  milli- 
grammes of  sugar  per 'cubic  centimetre  before  fermen- 
tation, (one  grain  for  every  fluid  ounce). 

Urea. — The  daily  quantity  of  urea  excreted  fre- 
quently becomes  of  importance,  and  various  methods 
of  estimating  it  have  been  advised.  None  are  so 
simple  as  the  one  proposed  by  Dr.  Davy,  of  England." 
Doubts  having  arisen  as  to  its  accuracy,  we  undertook 
a  series  of  experiments  in  order  to  ascertain  if  they 
were  well-founded.  The  results  of  these  experiments3 
seemed  to  show  that  the  method  is  in  every  respect 
sufficiently  accurate  for  practical  purposes,  and  it  is 
therefore  introduced  here  as  the  one  best  adapted  to 
the  physician  who  wishes  to  perform  the  analysis  for 
himself. 

This  method  depends  upon  the  decomposition 
which  ensues  when  urea  is  brought  into  contact  with 
sodium,  potassium,  or  calcium  hypochlorite. 

Nitrogen  gas  is  evolved,  and  being  collected  and 

1  Urinary  and  Renal  Diseases,  p.  198.    Philadelphia,  1872. 

»  Philosophical  Mag.  1854. 

a  New  York  Med.  Jour.,  Sept.  1872. 


ANALYSIS    OF    THE     UKINE.  79 

measured,  the  amount  of  urea  originally  present  is 
estimated.  The  following  are  Dr.  Davy's  directions  : 
"A  strong  glass  tube,  about  twelve  or  fourteen 
inches  long,  closed  at  one  end,  and  its  open  extremity 
ground  smooth,  and  having  the  bore  not  larger  than 
the  thumb  can  conveniently  cover,  holding  from  two 
to  three  cubic  inches  (50  c.c.),  each  divided  into  tenths 
and  hundredths  by  graduation  on  the  glass,  is  filled 
more  than  a  third  full  of  mercury,  to  which  afterward 
a  measured  quantity  of  urine  to  be  examined  is  poured, 
which  may  be  from  a  quarter  of  a  drachm  to  a  drachm 
or  upward,  according  to  the  capacity  of  the  tube. 
Then,  holding  the  tube  in  one  hand,  near  its  open  ex- 
tremity, and  having  the  thumb  in  readiness  to  cover 
the  aperture,  the  operator  fills  it  completely  full  with 
a  solution  of  Bodiuin-hypochlorite  (taking  care  not  to 
overflow  the  tube),  and  then  instantly  covers  the  open- 
ing tightly  with  the  thumb,  and  having  rapidly  inverted 
the  tube  once  or  twice,  to  mix  the  urine  with  the  hy- 
pochlorite,  he  finally  opens  the  tube  under  a  saturated 
solution  of  common  salt  and  water,  contained  in  a 
steady  cup  or  mortar.  The  mercury  then  flows  out, 
and  the  solution  of  salt  takes  its  place,  and  the  mixture 
of  urine  and  hypochlorite  being  lighter  than  the  solu- 
tion of  salt,  will  remain  in  the  upper  part  of  the  tube, 
and  will  therefore  be  prevented  from  descending  and 
mixing  with  the  fluid  in  the  cup.  A  rapid  disengage- 
ment of  minute  bubbles  of  gas  soon  takes  place  in  the 
mixture  in  the  upper  part  of  the  tube,  and  the  gas  is 
there  retained  and  collected.  The  tube  is  then  left  in 
the  upright  position  till  there  is  no  further  appearance 
of  minute  globules  of  gas  being  formed,  the  time  being 


80  ANALYSIS    OF    THE    URINE. 

dependent  upon  the  strength  of  the  hypochlorite  and 
the  quantity  of  urea  present.  But  the  decomposition 
is  usually  completed  in  from  three  to  four  hours ;  it 
may,  however,  be  left  much  longer,  even  for  a  day  if 
convenient,  and  having  set  the  experiment  going,  it 
requires  no  further  attention ;  and  when  the  decom- 
position is  completed,  it  is  only  necessary  to  read  the 
quantity  of  gas  produced  oif  the  scale  on  the  tube.  In 
cases  where  great  accuracy  is  required,  due  attention 
must  be  paid  to  the  temperature  and  atmospheric  pres- 
sure, and  certain  corrections  made  if  these  should  de- 
viate from  the  usual  standards  of  comparison,  at  the 
time  of  reading  off  the  volume  of  gas;  but  in  most 
cases,  sufficiently  near  approximation  to  accuracy  may 
be  obtained  without  reference  to  those  particulars." 

It  has  been  found  by  calculation  that  1  cubic  centi- 
metre of  gas  corresponds  to  2.5  milligrammes  of  urea 
— (1  cubic  inch  to  .64  grains). 

There  are  one  or  two  sources  of  error  to  be  avoided. 
Ammonia  and  uric  acid  will  give  rise 
to  nitrogen  and  thereby  increase  the 
apparent  amount  of  urea.  It  is  the 
former  which  is  most  likely  to  exist  in 
quantities  sufficient  to  cause  confu- 
sion ;  but  as  it  only  occurs  in  appre- 
ciable amount  during  the  alkaline  de- 
composition we  can  always  avoid  its 
FIG.  is.  eftect  .by  using  fresh  urine. 

The  apparatus  necessary  to  perform  this  analysis  is 
shown  in  Fig.  18.     The  graduated  tube  can  be  pro- 
cured of  Benjamin  &  Co.,  No.  10  Barclay  street. 
Sodium  hypochlorite  is  preferable,  to  either  that 


ANALYSIS     OF    THE     URINE.  81 

of  calcium  or  potassium  because  it  is  easily  pro- 
cured, being  an  article  in  general  use  under  the 
name  "  Liquor  Sodse  Chlorinatae,"  or  Labarraque's 
Solution.  But  there  are  various  preparations  of  this 
solution,  both  foreign  and  domestic,  which  do  not  cor- 
respond in  strength,  and  are  not  universally  kept  on 
sale.  We  are  in  the  habit  of  employing  a  preparation 
of  reliable  manufacture,  and  one  most  generally  sold 
in  the  United  States,  namely,  "  Squibb's  Liquor  Sodae 
Ghlorinatse,"  and  advise  its  use  in  connection  with  this 
analysis. 


PAET  VI. 

CALCULI   AND   GRAVEL. 

WE  have  seen  that  the  urine  is  subject  to  a  variety 
of  deposits.  Now,  under  certain  conditions  some  of 
them  are  precipitated  within  the  urinary  passages  in  a 
manner  to  form  solid  masses  of  considerable  size. 

When  the  masses  are  sufficiently  small  to  pass 
through  the  ureters  or  urethra  they  are  called  gravel 
and  sand /  when  too  large  to  admit  of  this  passage  they 
are  designated  as  calculi. 

It  is  important  to  be  aware  that  the  predisposing 
causes  of  the  small  concretions  conduce  alike  to  the 
formation  of  the  larger. 

Calculi. — By  a  urinary  calculus  or  stone,  we  mean 
those  solid  concretions  found  in  the  bladder  and  kid- 
ney, and  which  vary  in  size  from  that  of  a  pea  to  a 
hen's  egg.  They  differ  in  composition  as  well  as  in 
general  form  and  texture. 

As  regards  composition,  the  most  common  are  uric 
acid,  lime  oxalate,  urates,  phosphates,  and  cystine. 

A  stone  is  rarely  composed  of  one  substance  alone  ; 
T)ut  is  made  up  of  alternating  and  varying  concentric 
layers  of  different  deposits. 

In  the  first  place  the  center  of  almost  every  urin- 
ary concretion  consists  of  either  uric  acid  or  lime  oxa- 
late with  a  little  mass  of  mucus  ;  and  the  rest  is  corn- 


ANALYSIS    OF    THE     URINE.  83 

posed  of  layers  of  the  same,  alternating  occasionally 
with  the  earthy  phosphates.  And  if  the  process  is 
uninterrupted  the  stone  will  finally  become  encrusted 
with  successive  deposits  of  this  last  named  ma- 
terial. 

Calculi  originate  in  various  ways.  A  little  mass  of 
retained  mucus  or  blood  will  induce  the  acid  decompo- 
sition, and  determine  the  formation  of  uric  acid  and 
lime  oxalate  crystals  in  the  substance  of  the  mass,  and 
thus  constitute  the  nucleus  of  a  stone.  Foreign  sub- 
stances as  hair  pins  and  pieces  of  slate  pencil  are  not 
infrequently  found  to  have  originated  a  phosphatic 
stone.  Finally,  as  already  mentioned  when  studying 
deposits,  we  may  have  a  spontaneous  precipitation  of 
crystaline  or  amorphous  matter  taking  place  within  the 
body  as  a  result  of  retention,  and  consequent  decom- 
position, or  on  account  of  a  derangement  in  the  natural 
proportions  of  the  urinary  constituents. 

Whatever  be  the  origin,  the  subsequent  history  of 
calculi  is  soon  told.  There  are  alternating  layers  of 
various  materials  until  the  mass  begins  to  act  as  an 
irritating  foreign  body.  The  bladder  now  becomes 
inflamed  ;  retention  and  decomposition  ensue,  and  thus 
the  very  presence  of  the  stone  conduces  to  its  own  rapid 
growth.  Although  we  are  not  likely  to  meet  with  a 
stone  composed  entirely  of  one  material,  yet  this  may 
happen,  or  at  any  rate,  one  particular  substance  may 
predominate  and  impart  its  own  characters  to  the  mass. 
This  is  especially  true  when  removal  is  effected  early, 
prior  to  the  alkaline  decomposition. 

Uric  Acid. — Uric  acid  is  the  most  common  of  all 
deposits  going  to  form  calculi.  The  nucleus  of  almost 


84  ANALYSIS    OF    THE     UKINE. 

every  stone  is  composed  of  crystals  of  this  substance, 
and  not  unfrequently  we  see  it  constituting  a  stone 
almost  entirely,  especially  if  it  be  removed  before  the 
alkaline  fermentation  ensues. 

When  this  is  the  case,  the  size  rarely  exceeds  that  of 
a  pigeon's  egg.  The  color  ranges  from  a  brick-dust 
red  to  a  fawn,  and  the  surface  is  generally  covered 
with  little  tubercles ;  if,  however,  there  were  more 
than  one  stone  in  the  bladder,  their  surfaces  would  be 
worn  smooth  by  attrition. 

They  are  usually  spherical,  and  slightly  flattened. 
When  sawed  in  half,  their  concentric  laminae  are  very 
distinctly  seen. 

When  a  stone  of  this  composition  exists  in  the 
bladder,  the  urine  is  acid. 

TESTS. — The  murexid  test  is  the  most  direct  and 
characteristic.  Place  a  fragment  of  the  stone  in  a 
clean  porcelain  capsule,  and  add  one  or  two  drops  of 
nitric  acid  ;  now  evaporate  the  acid  by  gentle  heat 
over  the  flame  of  a  spirit-lamp,  and  a  pink  color  will 
appear,  which  changes  to  a  purple  when  a  little  am- 
monia is  dropped  in. 

Uric  acid  is  soluble  in  an  alkali  from  which  it  may 
be  precipitated  by  hydrochloric  acid  and  its  character- 
istic crystals  seen  under  the  microscope. 

Under  the  blow-pipe  it  is  converted  into  a  black  or 
very  dark-brown  coal. 

Urates. — Stones  composed  wholly  of  the  urates  are 
rare,  though  this  deposit  frequently  alternates  with 
others. 

When  pure,  they  are  small,  and  are  apt  to  originate 
in  the  kidneys.  Most  frequently  these  calculi  are  met 


ANALYSIS    OF    THE    UKINE.  85 

with  iii  children.  These  formations  are  of  a  red  or 
brick-dust  color.  The  urine  will  be  acid. 

TESTS. — The  fact  of  their  solubility  in  warm  water 
will  prove  the  presence  of  the  urates. 

Lime  Oxalate. — Like  most  other  deposits,  the 
lime  oxalate  more  frequently  forms  a  stone  by  alter- 
nation than  alone.  When  this  substance  exists  alone 
or  predominates,  the  stone  is  exceedingly  hard  and 
rough ;  in  fact,  it  has  been  called  the  mulberry  cal- 
culus, from  its  warty  and  irregular  surface. 

When  the  concretions  of  this  formation  are  small 
enough  to  be  classed  as  gravel,  and  are  voided  with  the 
urine,  they  may  be  smooth.  Here,  however,  there  is 
a  mixture  of  the  urates,  and  the  formation  has  proba- 
bly taken  place  in  the  kidneys,  and  by  their  number 
the  surfaces  are  worn. 

In  color,  these  stones  are  sometimes  dark  brown  or 
even  black,  and  again  almost  white. 

Most  mixed  calculi  contain  layers  of  oxalate  of 
lime. 

The  urine  will  be  strongly  acid. 

TESTS. — Oxalate  of  lime  is  soluble  in  the  mineral 
acids.  Under  the  blow-pipe,  it  is  reduced  to  a  dark 
ash  which  turns  moistened  red  litmus-paper  blue, — 
caustic  lime  being  the  residue  of  the  combustion. 

PHOSPHATES. 

We  have  seen  that  an  alkaline  condition  of  the 
urine  will  precipitate  the  earthy  phosphates,  and  that 
the  alkalinity  may  be  due  to  two  causes,  only  one  of 
which  is  concerned  in  the  formation  of  phosphatic  cal- 
culi. We  have  said  that  the  alkalinity  of  the  fixed 


86  ANALYSIS    OF    THE    URINE. 

salts  may  continue  for  a  length  of  time  without  a  stone 
being  found ;  because  the  phosphatic  precipitate  will 
then  be  amorphous,  and  has  little  tendency  to  form 
concretions.  But  when  putrefaction  occurs  from  re- 
tention of  urine,  or  the  action  of  inflammatory  pro- 
ducts anywhere  in  the  urinary  passages,  then  we  have 
ammonium  carbonate  developed,  and  now  crystals  of 
the  ammonio-magnesian  or  triple  phosphate  are  thrown 
down,  as  well  as  the  amorphous  phosphate  of  lime. 

It  is  the  ammoniacal  decomposition,  then,  which 
most  influences  the  formation  of  phosphatic  calculi. 

Sometimes,  however,  after  prolonged  administration 
of  alkaline  medicines,  and  as  a  result  of  high  living  (in- 
dulgence in  wine)  where  the  urine  is  kept  alkaline  by 
the  fixed  salts,  concretions  of  AMORPHOUS  LIME  PHOS- 
PHATE may  form. 

These  stones  are  light  colored,  easily  broken,  and 
present  an  earthy  fracture.  They  rarely  alternate  with 
other  forms. 

TESTS. — Lime  phosphate  is  insoluble  in  water; 
soluble  in  a  weak  acid,  and  is  practically  infusible  un- 
der the  blow-pipe. 

Mixed  Phosphates. — Deposits  of  this  nature  are 
the  result  of  the  ammoniacal  decomposition  of  urine, 
and  consist  of  the  crystalline  ammonio-magnesian 
phosphate  with  the  amorphous  lime  phosphate.  They 
rarely  constitute  the  whole  or  interior  of  a  stone,  but 
are  generally  added  as  the  result  of  the  presence  of  a 
pre-existing  calculus,  the  irritation  of  which  has  in- 
duced the  decomposition  just  mentioned.  And  it  is 
a  fact,  that  almost  every  stone,  if  it  remains  long 
enough  in  the  bladder,  will  be  encrusted  with  several 


ANALYSIS    OF    THE    URINE.  87 

layers  of  the  mixed  phosphates.  These  calculi  some- 
times attain  to  enormous  dimensions. ' 

They  are  chalk-colored,  and  have  a  glistening  ap- 
pearance on  account  of  the  presence  of  the  crystals  of 
the  phosphates  on  their  surface. 

TESTS. — Under  the  blow-pipe,  the  mixed  phosphates 
readily  fuse  into  a  white  enamel  (and  they  have  there- 
fore been  sometimes  called  the  fusible  calculi),  and 
give  off  ammonia  and  water.  They  are  soluble  in 
weak  acids. 

Cystine. — This  substance  sometimes  forms  calculi 
and  gravel.  The  number  of  cases  is  very  limited, 
and  very  few  specimens  of  the  concretion  exist.  The 
stone  is  quite  small,  not  larger  than  an  almond,  and  of 
a  dirty  brown  or  greenish  color.  There  appear  to  be 
no  distinct  laminas,  but  rather  a  radiating  structure. 
The  pathology  is  obscure. 

TESTS. — Cystine  is  soluble  in  the  mineral  acids, 
and  in  caustic  ammonia;  insoluble  in  water,  acetic 
acid,  and  ammonium  carbonate.  If  a  piece  of  the 
calculus  is  dissolved  in  a  little  caustic  ammonia,  con- 
tained in  a  shallow  dish,  upon  evaporation  the  char- 
acteristic hexagonal  crystals  already  described,  can  be 
detected  under  the  microscope. 

Cystine  burns  with  a  bluish  flame,  emitting  a  pe- 
culiar, unpleasant,  acid  odor. 


SCHEME  FOR  EXAMINATION  OF  URINE. 


Proceed  in  the  following  order  : 

1.  Odor. 

2.  Color. 

3.  Transparency. 

4.  Reaction  to  test-paper. 

5.  Specific  gravity. 
0.  Daily  quantity. 

7.  Any  deposit  ?    Character  of. 

8.  Apply  reagents. 


Heat. 

PRECIPITATES. 

DISSOLVES. 

\  Albumen. 
1  Phosphates. 

Urates. 

Nitric  Acid. 

(  Albumen. 

•j  Urea. 
/  Uric  acid. 

Phosphates. 

Liq.  Potassae. 

Phosphates. 

Albumen. 

Acetic  acid. 

Cystine. 

Albumen. 

Silver  nitrate. 

Chlorides. 

Barium  Chloride. 

Sulphates. 

There  are  certain  precautions  to  be  observed  with 
these  reactions,  for  which  reference  must  be  made  to 
the  text. 


GENERAL  DIRECTIONS. 

URINE  intended  for  examination  should  be  placed  in 
a  conical-shaped  glass  vessel,  such  as  an  ordinary  ale- 
glass,  in  order  that  any  deposit  which  may  appear 
shall  be  concentrated  in  a  comparatively  small  space  * 
for  if  there  is  a  very  minute  quantity,  we  otherwise 
might  not  be  able  to  secure  a  specimen  for  the  micro- 
scope, or  detect  its  presence  by  ordinary  inspection. 

After  the  specimen  has  stood  for  six  or  eight  hours, 
very  gently  pour  oif  all  but  about  half  an  ounce. 
This  is  done  in  order  to  prevent  the  deposited  crys- 
tals, casts,  or  whatever  is  there,  from  becoming  again 
mingled  with  a  great  quantity  of  urine  when  it  is 
agitated  by  our  subsequent  manipulations. 

Now,  having  provided  yourself  with  a  drop-tube, 
which  be  sure  is  clean,  place  the  finger  over  the  large 
end,  and  direct  the  other  end  to  the  bottom  of  the 
glass;  raise  the  finger,  and  the  urine  ascends  in  the 
tube ;  replace  the  finger,  and  we  have  it  confined  there. 
Touch  the  point  of  the  tube  thus  supplied  upon  a 
clean  glass  slide,  and  a  drop  will  escape,  which  is  all- 
sufficient.  A  thin  glass  cover  is  placed  over  this  drop 
on  the  slide  in  a  manner  to  exclude  air-bubbles,  as 
follows :  place  one  side  of  the  cover  on  the  slide  and 
allow  it  to  come  gradually  down.  If  the  cover  floats, 
there  is  too  much  urine,  which  will  overflow  it,  and 
obscure  the  lens.  Under  such  circumstances,  just 
absorb  the  surplus  urine  with  a  little  blotting-paper. 

We  need  a  good  ^-inch  lens  for  the  examination  of 
urinary  deposits,  and  sometimes  a  £-inch  in  order  to 
distinctly  discern  small  hyaline  casts. 


LIST  OF  APPAEATUS  AND   REAGENTS 
REQUIRED. 


Absolutely  necessary. 


APPARATUS. 


\  doz.  4-inch  test-tubes. 
Test  tube  rack. 
Alcohol  lamp. 
Small  glass  funnel. 
Filter-paper  to  fit  funnel. 
Red  and  blue  litmus  paper. 
Urinometer.  $2.00. 


f  Glass  flask  SOO.c.c.  (8  5  ). 
Cubic  centimetre  meas- 
Special  ap-J  ure. 

paratus.     j 

Glass  tube  graduated  to 
(^      cubic  centimetres. 


Quantitative  an- 
alysis of  sugar. 

Quantitative  an- 
alysis of  urea. 
$2.00. 


REAGENTS,    IK   GLASS-STOPPERED   BOTTLES. 

Nitric  acid,  4  §  • 

Acetic  acid,  4  § . 

Sulphuric  acid  (pure),  4  § . 

Solution  caustic  potassa  (20  gr.-l  3  ),  8  § . 

Sol.  copper  sulphate  (1  3  -1  5  )>  4  3  . 

Sol.  silver  nitrate  (10  gr.-l  5  ),  4  3  . 

Sol.  barium  chloride  (10  gr.-l  §  ),  4  ^  . 

$3.50. 


COMPARATIVE  VALUES   OP    FRENCH  AND    ENGLISH 
MEASURES  USED  IN   THIS  BOOK. 

1  gramme  =  15.434  grains. 

1  cubic  centimetre  =  0.061  cubic  inch  =0.27  3 . 

1  litre  =  61  cubic  inches  =  33.8  § . 

1  millimetre  =  ^j  inch. 

1  micro-millimetre  =  inch. 


INDEX. 


PAOK 

Acid,  Effect  of,  upon  Normal  Urine 19 

Acid  Fermentation  21 

Albumen 45,  64 

Abnormal  Urine 25 

Alkalies,  Effect  of,  upon  Normal  Urine 19 

Alkaline  Fermentation 22 

Apparatus  and  Reagents  required 90 


B. 

Bacteria 62 

Barium  Chloride,  as  Reagent 20 

Bile 72 

Blood 43 

Black  Urine 26 

Blue        «  ..26 


O. 

Calculi 82 

"  Cystine 87 

"  Phosphates 85 

"  Lime  Oxalatc 85 

"  Urates 84 

"  Uric  Acid 83 

Casts 47 

"  Blood 51 

"  Epithelium 50 


94  INDEX. 

PAGE 

Casts  Fatty 50 

"     Granular 51 

"     Hyaline 49 

"     Pus 51 

"     Waxy 52 

Changes  in  Urine  on  Standing 21 

Chlorides 19 

Cliylous  Urine 56 

Color  of  Normal  Urine 13 

Color  of  Abnormal  Urine 25 

Cold,  Effect  of,  upon  Urine 18 

Composition  of  Urine 5 

Creatiuiue 13 

Cystine 58,87 


D. 

Daily  Quantity  of  Normal  Urine 17 

"   Abnormal  Urine 29 

Deposits 30,  43 

Directions  for  examining  Urine 89 


E. 

Effects  of  Reagents  upon  Normal  Urine 18 

Epithelium 39 

Bladder 40 

Renal 40 

Urethral 40 

Vaginal 40 

Extraneous  Matters  in  Urine 53 


F. 

Feliling's  Solution,  Composition  of 75 

Used  as  Qualitative  Test 72 

Fermentation  Test  for  Sugar 68 

Fungi,  vegetable 60 


95 


.  PAOE 

Gravel »2 

Q  reen  Urine 2(i 

H. 

Haematuria 44 

HjBinatinuria 44 

Heat,  Effect  of,  upon  Normal  Urine 19 

Hippuric  Acid 85 

K. 

Keistine... 


L. 

Lead,  Basic  acetate  of,  as  Reagent 20 

Lime  Oxalate 21,  38 

Calculus.. .  . .  85 


M. 

Medicines,  Reappearance  of  in  Urine 20 

Moore's  Test  for  Sugar 63 

Mould  Fungus 60 

Mucus 41 


N. 

Normal  Urine,  Characters  of 5 


O. 

Odor  of  Abnormal  Urine 25 

Oil  in  Urine 55 

P. 

Penicilium  Qlaucuin ,    ..  60 

Pigments 42 


96 


Phosphates  ......................................   19,  22,  28,  36 

"          Ammonio-magnesian  ......................  22',  37,  86 

"          Earthy,  Precipitated  by  Alkalies  .................   19 

Stella  .........................................   36 

Calculi  ..........................................  85 

Pus  ...........  ............................................  53 


Q. 

Quantitative  Analysis  ...................  ...................  75 

"  "      of  Sugar  ..............................  75 

S'  "      of  Urea.  .  .  .  .  78 


R. 

Reaction  of  Normal  Urine 15 

"         "  Abnormal  Urine 27 

Reagents,  Effects  of,  upon  Normal  Urine .  18 

Required 90 


Saccharomyces  Cerevisiae 61 

Scheme  for  examining  Urine 88 

Silver  Nitrate,  as  Reagent 19 

Specific  Gravity  of  Normal  Urine 16 

"        "  Abnormal  Urine 29 

Spermatozoa . . .  • 58 

Sugar,  Tests  for 67,  68 

"      Quantitative  Analysis  of 75 

"      Fungus 61 

Sulphates,  Precipitation  of 20 


T. 

Transparency  of  Normal  Urine 15 

"  Abnormal  Urine 27 

Trommer's  Test  for  Sugar 69 

adapted  to  Urine 71 


INDEX.  97 

u.  PAOB 

U rates 18,  33 

"  Calculi 84 

Urea 6 

"  Nitrate 7,8 

"  Physiological  and  Pathological  Relations  of 9 

"  Quantitative  Analysis  of •. 78 

Uric  Acid 19,  21,  30 

"  "  Calculi 83 

Urinary  Deposits 30 

V. 

Values,  Comparative  of  French  and  English  Measures 91 

Vegetable  Fungi 60 

Vibriones -. . . .  62 

5 


